The pathology of mind

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THE

PATHOLOaY OF MIND.

BEING TEE THIRD EDITION OF THE SECOND PART OF

THE ''PHYSIOLOGY AND PATHOLOGY OF MIND;'

RECAST, ENLARGED, AND REWRITTEN.

BY

HENRY MAUDSLEY, M.D.

NEW YORK:
D. APPLETON AND COMPANY,

1880.

"\
\

J J ^

• • •

fc
b

*
k

PEEFACE.

The first edition of the Physiology and Pathology of Mind was
published in the year 1867, and the second edition in the
year following. A third edition of the first part was published
in the year 1876 as a separate treatise on the Physiology of
Mind. In the order of time and development this volume on
the Patliology of Mind is therefore a third edition of the second
part; but in substance it is a new work, having been recast
throughout, largely added to, and almost entirely rewritten.

The new material which has been added includes chapters on
" Dreaming " and on " Somnambulism and its Allied States,"
subjects which, although they may not perhaps be thought to
appertain strictly to a treatise on mental pathology, will be
found, when studied scientifically, to throw light upon its
obscure phenomena and to help to bridge the gap between it
and mental physiology. A perplexing impression was produced
on my mind when I first began to study mental diseases — now
upwards of twenty years ago — by the isolation in which they
seemed to be. On the one hand, treatises on psychology made
no mention of them, and gave not the least help towards an
understanding of them ; and, on the other hand, treatises on
mental disorders, while giving full information concerning
them, treated their subject as if it belonged to a science en-
tirely distinct from that which was concerned with the sound
mind. Inasmuch as psychological, physiological, and patho-

vi PREFACE.

logical studies of mind were actually coucerned with the sane
subject-matter, it was obvious that methods of study which
kept the different lines of inquiry entirely apart must be at
fault somewhere, and that it would be a right aim, and one
full of promise, to endeavour to bring them into relation with
one another, and so to make psychology, physiology, and
pathology throw light upon and give help to one another.
The first edition, as stated in its preface, was the firstfruits
of that endeavour, and the present volume, which embodies
the results of deeper studies and more ripened experience, is
the completion of it. The inclusion in it of chapters on the
abnormal mental phenomena which are exhibited in dreams,
hypnotism, ecstasy, catalepsy, and like states, is therefore a just
part of the fulfilment of the general design.

The same reason will, I trust, be held suflScient to justify
the large amount of new and in some regards disputable matter
which is included in the chapters on the "Causation and Pre-
vention of Insanity." It seemed proper to emphasise the fact
that insanity is really a social phenomenon, and to insist that
it cannot be investigated satisfactorily and apprehended rightly
except it be studied from a social point of view. In that way
only, I believe, can its real nature and meaning as an aberrant
phenomenon be perceived and understood. In recasting the
plan of the work I have thought it right therefore, in the
chapter on Causation, first to treat generally of the etiology of
mental derangement from a social standpoint, so fulfilling the
requirements of its organic relations, so to speak, in the social
organism; and, secondly, to treat particularly of its patho-
logical causation, so connecting it with the general pathology
of nervous disease, and answering the requirements of scientific
pathology.

In describing the symptoms of insanity, I have thought it
well again, first, to treat it generally as one disease, setting
forth the varieties of symptoms which it presents at different

PREFACE. vii

times and at diflferent stages of its course; and, secondly, to
occupy a separate chapter with the delineation of the different
clinical groups of mental disorders which are met with in practice
and have to be dealt with by the physician. In this way I
hope to have met the obligations of a true scientific exposition
and the more practical needs of those who have to form an
opinion concerning the cause, the course, the probable termina-
tion, and the proper treatment of a particular case of disease.
Had the chapter on Symptomatology been left out, the omis-
sion must needs have entailed a great deal of vague repetition
in the description of the clinical groups, with the certain effect
of blurring their outlines and features, and of confusing the
reader; had the special chapter describing these groups been
omitted, he would have obtained only a vague and general
notion of the symptoms of mental derangement, without that
more definite and practical acquaintance with its clinical
varieties, which, now that we are able, I think , to delineate
their features, ought to form part of a treatise on mental dis-
orders. "Whatever be the value of the clinical pictures in this
volume, they have certainly been drawn from life, and had
space permitted I might have illustrated each line of description
by the records of cases.

The fuU and analytical Index which has been added will
serve not only to make reference easy, but will enable the
reader to judge what sort of fare he may expect if he is
minded to make trial of it.

CONTENTS.

CHAPTER I.

TAOK

BLEEP AND DREAMING ••.••• 1

CHAPTER II.

HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES 50

CHAPTER III.

THE CAUSATION AND PREVENTION OF INSANITY 83

(a) ETIOLOGICAL,

CHAPTER IV.

THE CAUSATION AND PREVENTION OF INSANITY 127

(a) ETIOLOGICAL {continued).

CHAPTER V.

the causation and prevention of insanity 1v5

(b) pathological.

THE INSANITY OP EARLY LIFE

CHAPTER VL

nsfe

X CONTENTS.

CHAPTER VII.

PAGB

THE SYMPTOMATOLOGY OF INSANITY 296

CHAPTER VIII.

THE SYMPTOMATOLOGY OF INSANITY {continued) 356

CHAPTER IX.

CLINICAL GROUPS OF MENTAL DISEASE 432

CHAPTER X.

THE MOPvBID ANATOMY OF MENTAL DERANGEMENT. •••... 489

CHAPTER XL

THE TREATMENT OF MENTAL DISORDERS . 522

PATHOLOGY OF MIND.

CHAPTEE L

SLEEP AND DREAMING.

As we pass nearly the third part of our short lives in sleep it is
pleasing to think that the time so spent is not misspent nor lost.
Sleep marks that periodical suspension of the functions of animal
life, or life of relation, during which the organs that minister to
them undergo the restoration of energy which is necessary after
a period of activity. Waste of substance, which is the con-
dition and the result of active exercise of function, must bo
repaired during rest ; instead of its being a surprise, therefore,
that we sleep, the wonder would be if we did not sleep. In the
work and thought of the day is given out by degrees the energy
which has been stored up during repose. The need of repair is
as true of the organic functions, which never seem to sleep, as it
is of the animal functions, which sleep through so large a pro-
portion of our lives. For although an organ like the heart seems
not to rest day or night from the first moment of action unto the
last moment when it ceases to beat more, yet it plainly rests
between each stroke, gaining thereby in alternating snatches of
repose the energy for the next stroke ; and it is really at rest
during a longer period than it is in action — ^has rested more than
it has worked when its life-work is ended. If the heart of an
animal which is beating regularly when the chest is opened be
made to beat slowly by stimulation of its vagus nerve it will go
on beating for a long time ; but if its beats are c\\3iQikfi?asA Vj

2 PATHOLOGY OF MIND. [chap.

irritation of its sympathetic nerve it soon comes to a standstill
from exhaustion ; nutritive repair and the removal of the waste
products of activity cannot keep pace with the rapid con-
sumption of energy in the accelerated pulsations ; it is exhausted
as the gymnotus is exhausted when it has been provoked to re-
peated electrical discharges and can give no more shocks until it
has recruited its energies. The lowest animal forms, which seem
not to sleep at all, probably sleep, like the heart, in similar brief
snatches of rest. The organism is a self-feeding and self-repair-
ing machine, but it cannot do its repairs when it is in full work ;
it must have for its parts, as for its whole, its recurring periods of
adequate rest ; and the time comes at last when, like any other
machine, it wears out, is no more capable of repair, and when
the exhaustion which ensues is death — the sleep during which
there is no repair and from w^hich there is no awaking.

The conditions under which we go to sleep, the causes which
promote it, and the iU effects which follow the deprivation
thereof, are proofs of its true purpose in the animal economy.
"When we wish to sleep we shut out all external stimuli, as a
bird puts its head under its wing, banish all subjects of active
thought or feeling, and place our bodies in as complete a state
of muscular repose as possible: so sleep comes on insensibly
as a deeper rest, not as an abrupt change, stealing upon us as
darkness upon daylight. The general causes which produce it
are such as exhaust the energy of the nervous system, either
through suffering or doing, and so occasion fatigue of body and
mind ; they are muscular and mental exertion, when not too
prolonged, the weariness which follows great emotional strain,
when not too intense, and severe bodily pain. It is true that
w^e may by a strong voluntary effort, or under the spell of an
excitement, prolong the usual period of waking, and resist sleep,
although we are very sleepy ; but we cannot do so indefinitely,
for torpor and incapacity of mental function, delirium, and death
are the consequences of an entire deprivation of sleep.

In this connexion it is interesting to ask why we awake —
why, once asleep, we do not go on sleeping for ever ? Probably
very much as the power of the exhausted electric eel to give a
shock revives when restoration of energy has taken place by

1.] SLEEP AND DEEAMING. 3

nutrition during rest. A stimulus to the body, of external or
of internal origin, which would have been unfelt during the
deep sleep of exhaustion, or would have only been enough to
occasion a dream, suffices, as the sleep becomes light through
restoration of energy, to awaken the individual either directly or
by the vividness of the dream which it occasions. We should
not sleep for ever, I believe, if every external stinmlus were
shut out ; for the accumulation of nervous energy would awaken
us either spontaneously, or on occasion of the least internal
stimulus, which, as the organic functions are not suspended,
though they are more languid, during sleep, could not be shut
out. If these functions regained their full activity they might
directly cause waking. On the time at which we awake habit
notably has a great influence within certain limits ; when we
allow the nervous system so many hours for repose, we accustom
it to that allowance, and it learns to do its repairs within the
allotted time.

Of what are the physiological accompaniments of the occur-
rence of sleep we know nothing more than that the circulation
of blood through the brain is lowered ; not as cause probably,
but as coincident effect of the state of nerve-element. Blumen-
bach long ago took notice in a man whose skull had been tre-
panned that the brain swelled with blood and rose into the
opening when he was awake and thinking, and sank down again
when he fell asleep ; and the experiments of Mr. Durham, who,
having removed circular portions of the skull in different ani-
mals, and replaced them by suitable watch-glasses, through
which he could observe what happened when the animal was
awake and when it was asleep, convinced him that there was
considerably less blood in the brain during sleep ; its substance
then being paler and sinking down, while it reddened and
became turgid directly the animal awoke. The fontanelles of
young children sink during sleep ; and forcible compression of
the carotid arteries in the neck of the adult will induce it. There
is an active flow of blood to the part where the stimulus of func-
tional energy attracts and needs it, and when active function is
suspended by the recurring necessities of restoring the expended
energy by sleep, the circulation of blood falls to the level of

4 PATHOLOGY OF MIND. [chap.

the mere organic requirements of the brain : the supply answers
in fact to the different states of the brain, being active when its
functions are active, moderate when they are in abeyance. A
short step further has been made in conjecture. Knowing that
different parts of the brain are supplied with blood by diflferent
arteries, the main channels of which go on dividing and sub-
dividing into smaller channels until these become capillary, it
has been surmised that an active circulation may sometimes
be going on in certain vascular areas of the brain while the
circulation in other parts of it is lowered to the level of sleep,
not otherwise than as local blushings occur elsewhere in the
body from vaso-motor dilatations, and that these active local
circulations in the brain are the conditions of that modified and
irregular activity which constitutes dreaming : one part of the
brain is supposed to be more or less awake when the rest of it
is asleep.

Eecently the theory has been broached that sleep is caused
by the accumulation of the products of the oxidation which
takes place during activity ; they are not presumably removed
so rapidly as they are produced during active function, but are
carried away, like the refuse in some cities, during the repose of
the night. It is not known what is the exact nature of these
combustion-products, but it is assumed that they act upon the
nerve-elements very much as carbonic acid does, causing a sort
of narcosis when they accumulate. Any condition then which
hinders their removal from the brain, such as prolonged activity
thereof, will favour sleep ; any condition which accelerates their
removal will tend to prevent it.

Sleep is not a constant, but a fluctuating state. There are
degrees of sleep, not only of the cerebro-spinal system as a
whole, but of its different parts — so many intermediate steps
between it and waking ; wherefore we may be rightly said to
graduate through a twilight-waking into imperfect sleep, and
from light slumber into profound unconsciousness. It is hard
to say sometimes whether we have been asleep or not ; for the
wandering and incoherent ideas and the suddenly arising hallu-
cinations of a grotesque kind which occur just as we are going
to sleep are so like the vagaries of dreams, that we know not at

1.] SLEEP AND DREAMING. 5

all times whether they were part of our waking or of our sleep-
ing life. The stages in the gradually deepening unconsciousness
which is produced by opium illustrate very well the gradations
in the process of going to sleep : there is first a drowsy feeling
which becomes soon an irresistible inclination to sleep ; the
person then falls into a slumber from which he may be roused
sufficiently to make a reply to a question put to him in a loud
voice, thereupon sinking back immediately into sleep, which
deepens rapidly into a comatose unconsciousness from which
the severest pinching, slapping, and irritation of all kinds hardly
avail to elicit more than the least sign of feeling or the briefest
responsive movement ; finally he sinks into so deep a coma that
he is insensible to anything that may be done to him ; all the
tortures which savage ever devised and inflicted upon his enemy,
or Christian upon his fellow-believer of a minutely different
shade of faith, would not touch him — he is in the unconscious-
ness of death before death. One sense goes to sleep after
another, each sinking gradually into a deeper slumber, then
the spinal cord, and, last of all, the respiratory centre in
the medulla oblongata, when, the man dies. In the production
of insensibility by the inhalation of chloroform or of ether we
observe evidence that the person hears after he can no longer see,
and that the senses of taste and smell are lost before those of hear-
ing and touch ; and in natural sleep it is obvious that there are
similar gradations of unconsciousness, one sense being sometimes
more deeply asleep than another, or the spinal cord being awake
when the special sensory centres are fast asleep. A lightly-
sleeping person will sometimes hear apt questions that are cau-
tiously put to him in a familiar voice, and make a reply without
waking ; and there can be no doubt that a man will sleep on
horseback when the muscles of the back, among other muscles,
must be in action, or even sometimes when walking ; he cannot
sleep when standing still, because the body will be sure to fall for-
wards unless it be supported. In like manner when we awake,
it seldom, if ever, happens that all our senses awake at the
same instant; a sound is heard before the other senses can
receive impressions ; indeed they appear commonly to wake suc-
cessively. When we consider then that natural sleep is not

6 PATHOLOGY OF MIND. [chap.

really a fixed and constant quantity, but a fluctuating bodQy
state in which there are considerable differences in the degree of
insensibility of difierent parts, some being lightly and others
deeply asleep at the same time, it will not appear strange that
in some dreams active imagination is exhibited and skilful bodily
feats perfonned ; a proof that some mental and motor centres are
awake while others are asleep.

The variations of susceptibility of diflerent parts to impressions
during sleep is shown again by the ease with which a sleeper
may be awakened by a gentle sound or other stimulus to which
he is accustomed to respond, when a louder sound or other
stimulus that is really more powerful, but which he is not
accustomed to take notice of, has no effect upon him. In sleep
as in the waking state the ear hears best what it expects to
hear. Just as the expectation of a particular impression upon
waking sense increases the susceptibility of that sense and the
rapidity with which the message is conveyed from the external
organ to the central ganglion, so the adaptation of sleeping sense
to a particular impression engenders a habit of expectation, so to
speak, in the sense, by which its sensibility to the impression is
heightened, and this, though gentle, acts upon it with the same
efficacy as an extraordinary stimulus would do. If we think of
it, we observe that in our daily life impressions are hourly made
upon our senses of which we are not in the least conscious, unless
for some reason or other we are moved to take particular notice
of them ; we are, as it were, asleep to them habitually ; and it is
hard to conceive what potentialities of knowledge some of these
unperceived impressions contain, and what opportunities of per-
ception we let go by. We live actually in very limited relations
with external nature — relations limited not only by the capacities,
but by the habits of our senses — and become extremely automatic
in our reactions to the few stimuli which are habitually received ;
wherefore our intellectual and practical life runs in the main upon
a few fixed lines to which we are bound, as animals are constrained
by their particular instincts, and outside which lie vast un-
surveyed regions. We perceive only what we attend to, and we
attend only to that to which we have, by frequent repetition, or-
ganised an adaptation of sense and of suitable motor associations.

1.] SLEEP AND DREAMING. 7

Men little consider how mechanical they are in their thoughts,
feelings, and doings. So fully possessed are they with the fixed
but erroneous notion that consciousness is the essential agent in
all the purposive things which they do, that they stand amazed
when they witness any evidence of intelligent action during the
abeyance of consciousness, as in sleep, and look upon it as some-
thing marvellous ; whereas the real marvel would be if the
organism were entirely to forget its intelligent habits simply
because they were not lit up by consciousness. As a matter of
fact it does not forget them : it awakes commonly at its ac-
customed hour whether the person went to bed at his usual hour
or later, and awakes at any moment on the occurrence of the
least sound to which it is accustomed to awake, as when the
mother hears her baby's cry in the night, taking no notice of a
much louder sound which it has learned to disregard ; and it
awakens instantly on the cessation of a sound to the continu-
ance of which it has been accustomed in sleep, as is exemplified
by the well-known story of the miller who awoke when the noise
of his mill, which went on through the night usually, ceased
in consequence of the breakdown of the machinery.

It has been a disputed question whether sleep is ever quite
dreamless, and opposite answers to it have been propounded.
Some writers hold that no state of sleep, however sound it
be, is without dreaming ; not being able apparently to conceive
two different states of sleep so remote from each other as active
dreaming and complete suspension of mental function ; infected
also probably in some degree by the Cartesian dogma that the
mind never can be entirely inactive. Their contention is that
when we declare we have not dreamed, the truth is that we have
dreamed and have forgotten it ; and they adduce in support of
their argument such undoubted facts as these — the rapid and
complete way in which the most vivid dream often vanishes
from the memory, so that, although we awake with its features
clear in the mind, they are gone in a few minutes and caanot be
recalled ; the quite accidental way in which some trivial ex-
perience of the day will sometimes bring back the recollection
of a dream which we had entirely forgotten, and which but fat
that accident we should have forgotten ior e\eT \ viwfti,\^%^l>'^^

8 PATHOLOGY OF MIND. [chap

fact that other persons may have observed in our exclamations
and movements during sleep plain evidence that we have dreamt
when we, on waking, should be ready to assert confidently that
we had not Due weight may be granted to these facts without
admitting that they go the length of proving the position which
it is sought to maintain. The weight of evidence, in a case
which by the nature of things cannot be decided, I believe to be
really on the side of the opinion that the soundest sleep is a
dreamless sleep. The difficulty of conceiving a temporary nullity
of mental function one may take leave to dismiss as a lingering
prejudice from the metaphysical notion of mind as an exalted
spiritual entity whose essence has nothing in common with the
low material necessities of the body. When we make the matter
one of observation, it cannot be denied that we perceive during
sleep all shades of gradation between the most vivid and active
dreaming at the one end and the faintest show of evanescent
activity at the other end of the scale. What difficulty is there,
then, in passing in conception the imperceptible line between
the least flutter of activity and a complete nullity of function ?
Furthermore, in certain cases of suspended animation or apparent
death, as, for instance, when a person is taken out of water in a
completely unconscious state, and revives only after energetic
efforts at restoration continued for an hour or even for hours, it
is as certain as anything can well be that all mental function
was abolished from the moment he became insensible unto the
moment when sensibility returned. Take again the remarkable
case of a blow on the head producing depression of the skull,
pressure upon the brain therefrom, and insensibility therewith ;
with the raising of the depressed bone by surgical means the
person has not only regained consciousness instantly, but has
gone on to finish a sentence which he had begun when he was
struck down unconscious.^ In profound apoplexy, in the entire
insensibility which is produced by chloroform, and in similar

^ III the American Journal of Nervous and Mental Diseases for April,
1877, Dr. Hoy mentions the case of a youth, aged eigliteen years, who was
struck insensible by the kick of a horse, his skull being depressed and
fractured. After trephining the depressed bone he became sensible. Dr.
Hoy took advantage of the hole in the skull to make firm pressure on the
exposed brain after asking him a question. As long as the pressure

I.] SLEEP AND DREAMING. 9

states of complete unconsciousness from other causes, there is
not the least reason to suspect that there is any more mental
function going on than there is in an animal which has been
deprived of its cerebral hemispheres.

Another theory which has been broached with regard to
dreaming is that we only dream just as we are going to sleep or
just as we are coming out of it — ^in the transition state into and
out of sleep. But this opinion seems on examination to be less
tenable than the opinion that we never cease to dream when we
are asleep. Were the somnambulist not a positive refutation of
it, observation of sleeping persons who show plainly by their
actions or their words that they are dreaming and who still go
on sleeping, and the fact that we sometimes catch ourselves in
the midst of a dream when we are roused suddenly out of deep
sleep, would be sufficient to prove it erroneous. Inasmuch as
sleep is not a constant but a fluctuating state, it stands to reason
that there will often be varying degrees of mental function ac-
cording to the more or less depth and completeness of it ; there
will be sometimes an activity so coherent as to surprise us, at
other times an activity of the most partial and incoherent kind,
and there will be an entire abeyance of mental function during
such deep sleep as that which fell upon Adam when the opera-
tion of taking a rib out of his side was successfully performed.

It has been justly remarked that if we were actually to do in
sleep all the strange things which we dream we do, it would be
necessary to put every man in restraint before he went to bed ;
for, as Cicero said, dreamers would do more strange things than
madmen. A dream put into action must indeed look very much
like insanity, as insanity has at times the look of a waking
dream. In dreaming as in insanity there are the most strange
and grotesque deviations from the accustomed sober paths of

continued he remained silent, but the instant it was removed he made a
reply, never suspecting that he had not answered at once.

The same gentleman mentions another case of a youth, aged nineteen,
who was rendered insensible by the kick of a mare named Dolly. As soon
as the depressed botne was removed, he cried, " Whoa, Dolly," with great
energy, and then stared about him in amazement, wondering what had
happened to him. Three hours liad passed since the accident. He was
not conscious tlie mare had kicked ; the last thine: which he remembered
was that she wheeled round her heels and laid back \\^i ^w^»

10 PATHOLOGY OF MIND. [chap.

associations of ideas ; the combinations and sequences of ideas
do not follow any definite laws, so far as we can discover, but
appear often to be quite accidental and transitory; we justly
therefore set down the loss of all power over the succession
of ideeis as one of the leading phenomena of dreaming. It
is not true, however, as is sometimes said, that volition is
always abolished during dreaming ; for it is certain that we may
wake up suddenly out of sleep in consequence of a strong effort
of volition which we have made in our dream, as when we
strike out at a person who has insulted or assaulted us, and
that at other times we do voluntarily restrain the expression
of our feelings. I have been brought to the very verge of being
hanged on two or three occasions in my dreams, having
wakened up at the last moment before the operation was to
be performed, and on each occasion I have been conscious of
a determined suppression of any betrayal of fear or other
emotional agitation during the preparations for the event. A
concrete act of volition of that sort is not impossible in
dreams. It is a fair question, however, how far we succeed
in accomplishing the volition when it is to do something
active, and how near waking we are when we feel it. For
it happens in dreams that we find ourselves straining to do
something — for example, to strike a blow, to cry for aid, to
utter a command, and are perfectly impotent to do it; and
the instant we succeed in liberating our paralysed energies
we awake. There is the strongest mental volition, but an
utter impotency of motor outcome ; the instant which elapses
between the desire or will to do and the waking state being
long enough for the occurrence of what seems a much longer
drama of impotence in the dream. At the same time it
should not be overlooked that a person does not always
awake who calls out in his dream, and that we remember
dreams in which we imagined ourselves to wiU and to do
what we wiUed.

Certainly it is true that volition in its highest sense of
control over the mental operations is abolished in dreaming,
as a moment's reflection M^ill show must needs be the case.
For such volition is neither more nor less than the expression

1.] SLEEP AND DEEAMING. 11

of the fullest co-ordinate activity of the mental fuDctions,
varying much in quality necessarily according to the develop-
ment of the functions through previous training, and cannot
therefore by the nature of the case consist with the fortuitous
concourse of ideas in dreams. It is impossible there can be
full use of reflection when most of the habitual trains of
thought are suspended in sleep ; an idea that is accompanied
with desire is without the means of becoming a reasoned volition
in the ordinary way ; it must remain a particular desire, and
when it is active, instead of the natural results following
through the beaten paths of association, it will rouse some
strange, apparently unrelated idea, which being seen as a vision
will present itself as a sort of abrupt transformation scene.
For the same reason the sense of personal identity, the unity of
individual character, is confused and seemingly lost. We are
ourselves and somebody else at the same moment, as other
persons seem to be themselves and not themselves, and we do
absurd and perhaps transcendently criminal things in the most
matter-of-fact way, all the while mildly surprised or not at all
surprised at ourselves for doing them. How can there be a
clear sense of the unity of the ego, how any conscience, when
there is an entire abeyance of that co-ordination of mental
function, the self- consciousness of which is the feeling of
personal identity ? It is probable enough that when we begin
in our dreams to be surprised at the change of identity, and
to think about it as odd, we are on the point of waking ; the
commencing restoration of the co-ordination of functions being
in fact the restoration of the feeling of identity and the occasion
of our surprise. But it seems to me that throughout all the
vagaries of dreaming there is generally at bottom an obscure
feeling or instinct of identity, or else we should not ever be
surprised at ourselves when we seem not ourselves, or when we
are doing extraordinary things, or even have the sort of personal
feeling which we have in whatever odd drama we may be
playing a part. The reason I believe to be that the organism
preserves its identity notwithstanding that our conscious func-
tions are in the greatest distraction ; although we are asleep the
different impressions of our organic or systemic sensibility.

12 PATHOLOGY OF MIND. [chap.

which are not affected directly by external conditions, are carried
to the brain from the internal organs ; and it is this physiological
unity of organic functions, which is something deeper than
consciousness and constitutes our fundamental personality, that
makes itself felt with more or less force in every conscious state,
dreaming or waking. The insane inmate of a pauper lunatic
asylum who is possessed with the delusion that he is the Almighty
and can do in an instant whatever he wills, begs humbly a trifl-
ing favour at the same moment that he proclaims his omnipo-
tence. Such are the inconsistencies of a distracted identity.*

The absence of surprise at the extraordinary events which
take place in dreams is sometimes very remarkable. But it is
not always complete. In some instances there is a partial or
particular surprise ; not a surprise springing from a consistent
reflection upon the absurdity of the whole affair, such as
a waking man would make, but a surprise at a particular
startling inconsistency, as, for example, at the appearance of a
person whom we remember to be dead, to take part in the events
of the dream. On other occasions, there may be distinct feeling
that we are dreaming ; we may say to ourselves— It is only
a dream ; and perhaps resolve at the same time to go on with it
instead of breaking the spell, as we feel we might do at any
moment. When there is not so distinct a consciousness that the
affair is a dream, there is now and then a half-conscious under-
tone of question or doubt of the reality of the images which
flit before the mental vision : a sort of dim and vague feeling
of their unreality, as if they were parts of a dramatic show in
which we were so much interested for the time, so far carried
away, as to lose independence of judgment and even sense of
individuality. If this feeling becomes stronger it probably
produces the conviction that we are dreaming which we have
sometimes before we awake, and in the end awakens us. For I
imagine that we are very near waking when we get this con-
viction : that the co-ordinated functions, from the consentience
of which springs the consciousness of identity, are beginning
to be exercised. The dream-phantoms move across a back-
ground of the unconscious individuality, which, moulded and
fashioned by the habit of our life-experience, necessarily con-

1.] SLEEP AND DREAMIXa. 13

tradicts them absolutely the moment it becomes conscious, and
gives rise when only in a state of nascent consciousness to the
vague subconscious feeling of scepticism before it declares them
positively unreal. It is impossible we should be surprised at
the inconsistencies of a dream when we are in deep sleep,
because it is impossible we should then reflect — in other words,
impossible we should compare them with those organised mental
experiences which are the registrations of our observations of the
order of nature, seeing that these experiences are silent ; it
would be a wonder therefore if we did not accept as real, and
without surprise, the vagaries of dreams.

The idea which arises in the mind in a dream, being unable
to follow the accustomed paths of reflection, acts downwards
upon the sensory ganglion, and takes shape as a distinct image
or an actual perception, so that a dream-train of ideas is a train
of images. Moreover it is an image which we see very vividly,
because there is no distraction of consciousness by objects of
external sense or by related ideas, as we see the stars from the
bottom of a deep well in broad daylight because the line of
vision alone is then illuminated. The result is that what would
be a succession of ideas in the waking state, hardly perhaps
overstepping the threshold of consciousness, becomes a disorderly
succession of images, or, as it were, a series of abrupt transfor-
mation scenes in a drama. Taking Hobbes* celebrated instance
of association of ideas, one might consider curiously what it
would become supposing it were to occur in a dream. " For in
a discourse," he says, "of our present civil war, what would
seem more impertinent than to ask, as one did, what was the
value of a Eoman penny ? Yet the coherence to me was
manifest enough : for the- thought of the war introduced the
thought of the delivering up of the king to his enemies ; the
thought of that brought in the thought of delivering up Christ ;
and that again the thought of the thirty pence, which was the
price of that treason ; and thence easily followed the malicious
question " {Leviathan, i ch. iii.). In the dream there would be
so many scenes rapidly following one another, or jumbled con-
fusedly together, and when the dreamer awoke and called to
mind the details of his dream, he might be at a loss to account

14 PATHOLOGY OF MIND. [ch^p-

for the strange conjunction of persons and incidents in the spec-
tacles that had been presented to him, and for the sudden trans-
formation of one spectacle into a quite different one. And
wliereas in this case we suppose that there were true, though
unperceived, links of association between the ideas, for which
reason the scenes did not follow one another without coherence,
it is probable that in many dreams the ideas which become
ti*ansformed into images call up one another in a fortuitous way,
and so produce more incongruous scenes.

The fantastical deviations from the ordinary tracks of associa-
tion of ideas, the loss of volitional power over the ideas, the sus-
pension of conscience, the distraction of the ego, and the seem-
ing reality of the grotesque dream are all parts of the same
effect; they proceed from a discontinuity of function in the
supreme centres of the brain, a temporary suspension of the
bonds of their functional unity. As when a complex assemblage
and series of movements which have been trained to the execu-
tion of certain complicated and special effects can no longer bo
performed because of some disorder in the proper motor centres,
but in their stead spasmodic, incoherent, and purposeless move-
ments are displayed, we might say that the usual motor associa-
tions were broken up, volitional power abolished, and their
essential identity as specially purposive functions destroyed, so
it is with the co-ordinated functions of the supreme cerebral
centres in dreaming ; its phenomena express different degrees of
loss of co-ordination — that is to say, different stages in the
resolution or disintegration of the most complex integrations of
mental evolution.

It is sometimes said that in dreaming there is a loss of the
faculty of combining and arranging ideas. True it is that there
is usually a loss of the faculty of combining and arranging them
as we do when we are awake ; but one of the most remarkable
features of dreaming, which has hardly had the consideration
which it deserves, is the singular power of combining and
arranging ideas into the most vivid dramas. It would be no
great exaggeration to say that the dramatic power of a dunce in
dreaming exceeds that which is displayed by the most imagina-
tive writer in his waking state. When we reflect upon the

L] SLEEP AND DREAMING. 16

extraordinary creations of dreams, and consider that the most
stupid and unimaginative person often constructs scenes, creates
characters, and contrives events with a remarkable intensity of
conception, distinctness of outline, and exactness of details,
putting into the mouths of his dramatic persons dialogues suited
to their several characters, we might well conclude that there is,
independently of will or consciousness, a natural tendencfy of
ideas, however stirred, to combine and to arrange themselves into
a kind of drama, even though they have no known associations
and appear quite independent of, if not antagonistic to, one
another. Ideas in this respect might be compared rudely to
such chemical substances as, the moment they are set free to
yield to their affinities, rush together to form a compound of
some kind. The same sort of thing occurs in the waking state
when the succession of thoughts is not controlled by reflection
upon some definite subject, and it constitutes the chief part of
the mental activity of a great number of persons who, when not
engaged in practical work, spend their time in vacant reverie,
or in rambling incongruities of ideas. Were a faithful record
kept of the fantastical play of ideas under these circumstances,
it would often read as wild as any dream. The point, however,
which I desire to lay stress upon, and to fix attention to here,
is the tendency of ideas, however unrelated, to come together,
and to form some sort of mental imagery, wildly absurd or more
or less conformable to nature — the actual constructive power
which they evince ; fprit plainly indicates that the plastic power
of mind, its so-called imagination, is at bottom organic function
of the supreme cerebral centres; something which, being dis-
played when will is in abeyance and consciousness a mere
gleam, whenever there is the least display of cerebral mental
function, must plainly lie beneath consciousness and beneath
will. It is, if you ^ill, unconscious mental function. It is not
merely an association of ideas, and is not explained, as some
persons seem to think, when it is referred to that so-called
principle, to which they are in the habit of attributing extra-
ordinary powers. The principle of association of ideas is nothing
more than the statement that ideas which have occurred together
or in sequence, or which have sometliing \\k^ m ^Jtkfiai»^*■^

2

16 PATHOLOGY OF MIND. [chap.

probably occur together again, one calling up the other. But
we are dealing with something more than that — with an actual
constructive agency, whereby ideas are not brought together
only, but new products are formed out of them. The scene
presented may be one which has never been actually ex-
perienced, nor is it always made up by the combination of
images which have been experienced. Both the scene and the
images are many times new, though suggested by similar scenes
or images seen in part or in whola

It is noteworthy in this relation how in dreams a general idea
is resolved into suitable concrete images, such as it might have
been derived from by abstraction, but which it never was actually
derived from, although no doubt it was the abstract of somewhat
similar experiences. A casual suggestion in the day — for instance,
that a person has great tact or great courage, may be the occa-
sion of his taking part in the scenes of a dream, and doing things
which we should consider to evince tact or courage, notwith-
standing that the scenes are entire creations of fancy and such
as he never could have mixed in. The general idea creates the
scenes of its appropriate display, being resolved as it were into
the concrete elements out of which it might have been developed.
This is an entirely involuntary operation, and proves, as is
proved also by the formation of the general idea in the first
instance — not in the least a voluntary procedure — ^that mind is
capable of those intelligent fimctions which are the essence of
its being, independently of will and of consciousness, or at any
rate that the potentiality of them lies not in consciousness nor
in will, but in the plastic quality of the brain. As the unknown
organic power in a living cell — whatever complexity of intimate
physico-chemical processes its vitality may connote — assimilates
what is suitable to its growth in its surroundings, and so builds
up by degrees an individual being in conformity with the lines
of development that are laid in its nature ; so the special organic
power of the nerve-elements in the supreme centres of the brain
builds up by degrees in adaptation to the co-existences and
sequences of the surroundings, social and physical, the complex
structure of the mental organisation of the individual. But it
cannot transcend the lines that are laid down for it in the

I.] SLEEP AND DEEAMING. 17

inborn capacities of the individual nature : what the mental
organisation will turn out to be will depend, first and foremost,
upon the inborn capacities which he has inherited from ances-
tors, and, secondly, upon the influence of education and of the
circumstances of life. As with the seed of a tree dropped in a
forest : its original germ-force may be greater or less, its situa-
tion more or less favourable, but it will take root and flourish,
and surpass other trees in growth, according to the advantage of
the position in which it has chanced to drop, and according to
the power which it has, through original strength of stock, of
profiting by opportunity and getting the most out of its sur-
roundings. We rightly look upon mind as the highest force in
nature, but we are wrong to look upon it as a power outside of
and above nature, self-sufficing, without relations of dependence
or affinity ; while looking up to the height of its noblest func-
tions, we ought not to overlook the depths in which their roots
are planted. The intellect is developed out of sensation and
motion, in other words, out of the capacity to receive and assimi-
late suitable impressions and to respond to them by definite
movements, whereby man as a part of nature takes his part in
its evolution, being acted upon by it and reacting upon it ; and
will is the impulse which, springing at bottom from the organic
life and displaying itself in desire, is guided by the intellect to
eftect improved conscious adjustments to the social and physical
environments. But the capacity to receive and assimilate suitable
impressions, and to reject and eschew unsuitable impressions, is
nowise a peculiar mental endowment ; it is a fundamental pro-
perty of organic element Man is not a mixture or a compound
of body and mind, but one being, having, magnet-like, two
polarities — the one linking him to that which is below him, the
other, representing his spiritual aspirations, having opposite and
higher attractions.

The plastic power of the supreme cerebral centres on which I
insist as something deeper than conscious mental function,
evinces its spontaneous and independent nature in a striking
way by those singularly coherent dreams which everybody has
at one time or another, and in which he sometimes puts forth as
much intellectual power as he ever displays when awake. Many

J 8 PATHOLOGY OF MIND. [cHAf.

stories have been told, on good authority, of persons who have
in their sleep composed poems, solved hard problems in mathe-
matics, discovered the key of a perplexing difficulty, or done
like wonderful things ; and while bearing in mind that dream
achievements which seem to us very clever at the time prove
oftentimes to be nonsense when we awake, it may be granted
that one who is fitted by natural abilities and training to do
good intellectual work when awake may occasionally chance to
do it in sleep, getting the good of a good understanding even in
his dreams. These instances illustrate the spontaneous nature
of the process of creative activity, with which consciousness and
will have no more to do as active agents than with the imagina-
tive creations of the inspired poet ; for it is only when the pro-
ducts are formed that they rise into clear consciousness, and only
when they are known that they can be willed. Another fact in
regard to the dramatic power displayed in dreaming which
should not pass unnoticed is the apparent rapidity of its action,
whereby is presented in an instant what would take us perhaps
hours to think out consciously, or to describe adequately in
words. A tragedy or comedy of several acts is devised and
performed in a moment ; it is no great wonder therefore that it
does not occur to one whose conscious ego is in abeyance that
he is the author of the various characters that figure in it and of
the scenes in which they play. He assists, happy or distressed,
applauding or condemning, at a spectacle which is all his own
creation, and has not the will or the power to modify its course
in the least.

One matter more in relation to the mental power of the
dreamer I shall take notice of, namely, the singularly vivid
recollection which is sometimes shown of things of which he
has not the least remembrance perhaps in the waking state.
* He can lay under contribution the long unused stores of
memory, draw from them things new and old, and so give
variety to his scenes in a way the waking person cannot do by
any strain of conscious recollection ; for the details of events
long past, the feelings that accompanied them, the features of a
face long dead, the tones of a voice that is still, are reproduced
with a surprising vividness and accuracy. This fact, which has

1.] SLEEP AND DREAMING. 19

its parallel in the experience of delirium and in the momentary
flash of recollection which occurs just before the unconscious-
ness of drowning, goes to show certainly, first, that there is no
such thing as forgetting what we have once attentively observed
and made part of our mental experience, and secondly, how
little consciousness has to do as agent in the essential parts of the
functions of recollection and imagination. When we are awake
our mental energies are engrossed in certain lines of habitual
activity which are determined by our usual pursuits and experi-
ences— they run in certain customary tracks, to which con-
sciousness is almost exclusively attracted; for habits and
external impressions control and determine our thoughts much
more than we think, so that in the deepest reverie they never
get so far a-field as when all external impressions are shut out.
But when we are asleep and no external impressions are per-
ceived, the tracks of habitual function are not pursued, ideas
are aroused independently of their associations by physical
causes, and there is not consequently a corner of the brain in
which there is a memory registered that may not be stirred into
unwonted activity. Inasmuch as there is then nothing to dis-
tract consciousness from the idea which emerges into momen-
tary activity, it is remarkably vivid ; and inasmuch as its related
ideas are at rest, there is no correction of it and it stands
out in exaggerated proportions.

In searching then for an explanation of the remarkable
revivals of forgotten events in dreams we must take into
account — (1) The absence of external impressions linking the
mind to certain tracks of habitual function which would not be
calculated to lead to the forgotten events, and, as a probable
concomitant effect, the opening up of disused or neglected
tracks which might lead to them ; (2) the direct stimulation of
the remotest nerve elements through the circulation of blood,
which, flowing in multitudes of minute channels through the
most intimate recesses of the structure of the brain, will,
according to its variations in quantity and quality and in rapidity
of flow, stimulate into activity the nerve-cells with which it is in
relation^ and obviously act indifferently upon the most remote
and most recent registrations ; and (3) tliepxoba\Aft s,\iTa^^\]v^"£iVi

20 PATHOLOGY OF MIND. [chap.

some internal organ of the body of that part of the brain with
which it is in special internuncial relation, or, in other words, in
which it has cerebral representatioa

Whatever the explanation, the fact is indisputable that persons
recall in dreams names and things which they had entirely for-
gotten, and which, while remembering them, they are not perhaps
conscious are remembrances ; just as thoughts in the day which
appear as new acquisitions may be found to have been entertained
before, or to have been derived from some book which was read
long ago. Maury relates the following amongst other instances.
In his early years he visited Trilport, a village on the Marve,
where his father had built a bridge. Later in life he dreamed
once that he was a child playing at Trilport, and that he saw
a man clothed in a sort of uniform, whom he asked what was

his name. The man replied C , and that he was gatekeeper

at the bridge, and disappeared. Maury awoke with the name

C in his ears, which he did not in the least remember ever

to have heard. Some time afterwards, however, he inquired of
an old servant, who had been in his father's service, if she

recollected a person named C ; and she replied instantly

that he was gatekeeper at the Marve when the bridge was built.
Dreams themselves are notably soon forgotten, partly no doubt
because of the little concern which they have with the real
experience of life, and partly because of their incoherent
character : we cannot recollect one-hundredth part of what we
see and hear and feel and think and do in a day, and should
be very unwise to attempt to 'do so within the conditions of our
limited capacity of memory and of our short span of life ; and
whoever will listen for a few minutes to the utterly incoherent
talk of a thoroughly demented lunatic, with the resolution to
remember and repeat it immediately afterwards, will learn by
his failure how much incoherence hinders recollection.

We see in our dreams multitudes of faces which we do not
in the least remember to have seen when awake : do we invent
them, or do we recall actually experiences which have been for-
gotten ? It is certain that an inhabitant of any large and busy
city sees in a few days hundreds of faces which he never could
voluntarily recall, and it is possible that some of these may

I.] SLEEP AND DREAMING. 21

come back from time to time as dream faces. It seems to be pretty
certain too that tlie face of one dream, not remembered in the
waking state, may appear and be remembered in a subsequent
dream. Dream faces may then be reproductions, not inven-
tions; but it is more probable that we invent them, just as we
invent scenes and events, and even words which we imagine we
understand clearly, but which are apt enough, if they remain in
our ears when we awake, to turn out to be nonsense. The action
of imagination in dreams as in the waking state is doubtless
productive as to form, reproductive as to material.

Passing now from these general observations and reflections
concerning dreams, I go on to inquire into the causes and
conditions which seem to determine their origin and their
character ; and I propose to consider and class them under six
principal headings, rather for convenience of discussion than
because the conditions are separate in fact and can be separated
in their working. These are : —

(1) Character and precedent mental experience.

(2) Impressions on a special sense.

(3) The state of the muscular sensibility.

(4) Organic or systemic impressions,

(5) Conditions of cerebral circulation.

(6) The state or tone of the nervous system.

1. Character and Precedent Mental Experience. — ^We should
plainly never dream at all, but sleep the dreamless sleep of the
newborn infant, had we not some mental experience to draw
upon : the material of our dream-fancies, the elements out of
which new products are formed, we derive from experience. It
is a common observation that the thoughts and feelings of the
day reappear under various guises in dreams, the more probably
the more vividly they have affected us at the time ; and some
persons are so susceptible that any strong feeling or conception
which they have had in the day is sure to make itself felt in a
dream at night. Certainly most use is made for dream imagery
of immediately antecedent or comparatively recent experiences,
which are revived by direct associations, old experiences be-
coming indistinct and perhaps even extinct sometimes ; still it

22 PATHOLOGY OF MIND. [chap.

is remarkable how vividly we revert now aud then to long
distant and forgotten experiences of persons, places, and the like,
either on the occasion of some chance stimulus in the day to old
associations, or in consequence of some unusual perturbation
of the bodily state stirring their substrata into activity. Dr-
Darwin mentions the case of a gentleman who, having been so
deaf for thirty years that he could be conversed with only in
writing or by the finger alphabet, assured him that he never
dreamt of persons conversing with him except by the fingers or
in writing, and had never had the impression of hearing them
speak. But it is nowise clear that this gentleman's early ex^
periences of speech were totally lost ; they might have been
revived in some dream had a suitable stimulus chanced to occur.
The leading experiences of our early days are certainly often
revived in dreams, many scenes of which notably testify to the
memories of school or college experience. And the character of
the scenes into which the materials, whether recent or old, are
worked will be much affected by the character of the individual
dreamer, who, according as he be proud or humble, aggressive or
retiring, bold or timid, sanguine or melancholic, revengeful or
placable, generous or mean, candid or cunning, will not fail to
find himself in his dreams. In this influence of character there
may be said to be a reversion to ancestral experiences and an
awakening of their substrata to activity; for a person who
exhibits a trait of his grandfather's character might be said to
repeat or remember what his grandfather felt.

Besides the patent and direct associations which are easQy
traced, there are indirect and subtle ways, not easily traced, by
which a suggestion or incident of the day may revive memories
of the past. A sensation which has been associated with some
mental experience of a long time ago — a particular sound, for
example, or, better still, a particular odour — will sometimes
bring back in a dream the conceptions and feelings of that ex-
perience, although it may have been only a momentary percep-
tion, and may not have awakened any associations in the day ;
aud a particular idea or a particular feeling which has passed
quickly through consciousness as a transient and isolated state
will do the same thing. I get a momentary whiif of some

I.] SLEEP AND DREAMING. 23

peculiar odour as I pass along the street, and I dream at night
of scenes of boyhood that were associated with that odour, but
of which I hiad not even thought in the day : I see a man or
hear his name mentioned in the day, and his wife, of whom I
never thought in the least, has a place in my dream. It is
probable that these passing hints or occasions of the day furnish
much of the explanation of the apparently mysterious manner
in which, with nothing that we can conceive to evoke their
recurrence, we go back in our dreams to scenes and events of
an early period of our lives. Knowing the many influences to
which we are exposed in a day, some of them scarcely conscious,
the multitude of ideas that pass through the mind, the variations
of feeling which we undergo, it is obvious that we have here
the possible explanation of the occurrence of many dreams
which perplex Us mightily. Hidden and unused paths of asso-
ciation are hit upon and pursued, and lead to the recovery of
forgotten experiences. It should be borne in mind in this rela-
tion that an idea, when excited to activity, does not strike one
chord of association only, biit strikes one. chord predominantly,
so that the others die away unperceived, which were neverthe-
less in partial vibration : during sleep another than the accus-
tomed chord may respond most actively, and so lead to the
revival of less familiar associations than those which are habitual
in the waking state.

Note this again : that a natural feeling occasioned by some
scene or event of the day will call up in dreams scenes or events
of the past which, when they happened, had caused a similar
feeling, but which are themselves as entirely unconnected with
the recent event as they are distant from it in time. For ex-
ample, some unpleasant occurrence in the day is a painful rebuff
to our self-love and excites a mingled feeling of depression and
humiliation ; the sad feeling, lingering, as such feelings will, as
dull depression after we have ceased to think about it, persists
through sleep and is translated into appropriate imagery; we
thereupon dream of our school-days, if they were unhappy, in
which we underwent similar humiliations of feeling, combining
perhaps the persons and incidents of those days with the persons
and incidents of the event which has affected \is ^a\aMi\:5. ''SXi^^

24 PATHOLOGY OF MIND. [chap.

allied feeling has called up an almost forgotten tmin of sympa-
thetic ideas, and we are not a little astonished even in our dream
to find our adult selves in such a painful position of school-boy
subordination. In like manner a gay feeling of elation occa-
sioned by some flattering experience of the day will get concrete
interpretation or representation in suitable dream-imagery.

One is apt to think that the images and events of a distressing
dream are the causes of the feeling of distress which is expe-
rienced, but they are not really so ; the feeling is more truly
the cause of the images ; it is, so to speak, the mother-mood of
them. A well-known habit of the mind is to seek for and to
create, if need be, with or without distinct consciousness, an
outward object as the cause of its feelings ; if there be no objec-
tive cause of them, it will invest some indifferent objects with
the attributes proper to produce them, or will altogether create
suitable objects ; and this tendency is forcibly illustrated in
dreams and in insanity. Coleridge has aptly remarked that
the images of dreams undergo the strangest and most sudden
metamorphoses without causing much or any surprise, and that
they disappear, together with the agonies of terror accompanying
them, the moment we awake ; which would not be the case if
they caused the terror which they appear to do. In like manner
the painful delusions of one who is suffering from that form of
profound mental depression which is known as melancholia
undergo changes sometimes — perhaps from terrible to grotesque
— without the least change in his distress ; the latter indeed
may exist for some time as a vague and terrible feeling without
any definite delusion, and it is a matter of accident rather than
of the essence of the disease what shape the delusions take. In
this generation or crystallisation of the images of fear out of
the troubled feeling we perceive a demonstration of the true
nature of so-called ghosts and apparitions : they are the effects
or exponents of the feeling of expectant apprehension which has
been engendered by reading or talking or thinking about them.
When Luther saw the Devil enter his chamber at Wittenberg
and instantly flung the inkstand at his head, he seems to have
been neither horrified nor greatly surprised, and to have re-
sented the visit rather as an intrusion which he had expected

I.] SLEEP AND DREAMING. 26

'from an adversary with whom he had had many encounters ;
but had the Devil really surprised Luther by walking into his
chamber, I doubt whether he would have been so quick and
energetic in his assault. Those who see ghosts under these
circumstances of mental preparation do not suffer much in con-
sequence, though they may protest when they narrate their
story that their hair stood on end and that they were in an
agony of fright ; whereas those who have been actually scared by
a sudden apparition — by a figure mischievously dressed up as a
ghost, for example — have often suffered seriously from the shock,
having fainted or fallen in a fit, or had a brain-fever in conse-
quence, or been killed outright by the shock. In the one case
the apparition was to a mind suitably prepared for it by an
antecedent state of feeling, and gave the vague feeling form,
wherefore there was no great surprise ; in the other case it came
unexpectedly upon a mind that was not attuned to it, therefore
with a great shock, and was correspondingly disastrous in its
effects.

It would be a long task to deal adequately with the pheno-
mena of dreams, and a book, not a chapter, would be necessary
to set forth the results of a full inquiry. I shall content myself
with relating a dream which was one among several vivid dreams
that followed one another on an unresting night of dreams, in
order to show how the most incongruous circumstances may, if
examined with sufficient care, be traced to incidents in past
experience. I was in a large building crowded with people,
which was partly like a church and partly like a public hall,
when two clergymen who somehow became three walked up a
middle aisle to the pulpit which stood on one side of it, two of
them turning aside to go into it, and the third continuing his
way along the aisle towards the place where the altar would
stand ; disappearing, however, mysteriously, aisle and all, after
he had gone some way. One of the clergymen was deformed,
being bent nearly double, and the pulpit, as soon as he got into
it, was transformed into something like the platform of a public
hall with seats rising in rows behind it and crowded with people,
at the end of one of which I stood. One of the clergymen
began the service or the proceedings by reading an opening

26 PATHOLOGY OF MIND. [cdap.

verse which I was a little surprised not to recognise, and the •
other, instead of going on, as I had expected, with the " Dearly-
beloved *' of the Prayer Book, went on to read a tedious story from
some strange book until I was wearied ; when suddenly, as I was
wondering to myself what in the world he was reading, an old
man in the body of the church or hall shouted out, ** Beautiful
death be damned, let us handle life," — and then began to give
out a hymn like a parish clerk of the olden time. There was a
general start of amazement throughout the congregation, and I
turned round, and, placing one hand before my eyes, laughed
heartily to myself. At that moment a German friend whom
I had not seen for years stood before me, and 1 awoke.

Such was the dream, and the interpretation of it was as
follows : — The hall was a combination of the old parish church
which I used to attend when a boy, and of St. James's Hall,
where I had lately been at a crowded public meeting, sitting on
that occasion behind the platform. The deformed clergyman
was like a gentleman whom I had been in the habit of seeing
in the street frequently, ten years ago, as he lived next door to
me, and whose appearance had made an impression upon me.
He was not a clergyman, nor had he the least connection with
any event of my life, and how he came to take part in the
dream I cannot imagine. The long story which he began to
read in the pulpit, instead of the proper address to the people,
was evidently suggested by the fact that I had read that day in
a newspaper a paragraph professing to give an account of Dr.
Newman's daily life at the Oratory, Birmingham, in which it
was told that while the brethren of the Oratory were at dinner
one of them read aloud the life of some saint or other in-
structive matter. The outburst of the old man who resembled
in manner, though not in face, the parish clerk of my early
days, was derived from my remembrance of a well-known passage
from Jean Paul, which had often been in my mind — " Oh ! how
beautiful is death, seeing that we die in a world of life and
creation without end ! " and the latter part of his exclamation
was clearly suggested by the familiar lines of Tennyson :—

" *Tis life, not death, for which we pant,
More life, and fuller, that we want"

I.] SLEEP AND DREAMING. 27

The turning round and laughing to myself with my hand
before my eyes was a trick of my German friend when he was
amused at any meeting with what he called a " capital humbug : "
my repetition of his movement had brought before me the
image of my friend. The whole dream was the affair of an
instant, for it was on a night when I no sooner got to sleep than
I began dreaming furiously and was awakened again. A few
nights afterwards I found myself in a dream endeavouring
eagerly to trace the associations of my dream, no doubt in
consequence of the particular attention which I had been lately
giving to the events of my dreams and of my efforts to explain
them.

Under the heading of precedent mental experience, albeit not
personal experience, one might class instances of what seem to
be reversions in sleep to ancestral modes of thought, feeling, and
action. Take, for example, the case mentioned by Darwin,
of the gentleman who used to make a peculiar movement of
the right arm when fast asleep, raising it slowly in front of the
face and then letting it drop heavily on the nose, and whose son
and granddaughter made exactly the same movements when
they were sound asleep.^ Here nervous substrata stimulated in
sleep gave out in motor function what had been embodied in
their constitution by ancestral experiences. What is to prevent
a materialised mental experience being aroused in the same
way ? Such a common saying as that " It is his father's trick
all over " may be as true of mind as of body, and as true of the
dreaming as of the waking mind.

I pass on now to consider the second class of dream stimuli.
I have said enough to show that the least occasions in the day
may lead to the revival of experiences that have long lain in
oblivion, and to their employment in the strangest and most
novel dramatic constructions, and to prove also that the combin-
ing and creative power which lies at the root of what we call
imagination is something which is spontaneous in character,

^ Darwin on The Expression of the Emotions in Man and Animals. See
also a suggestive paper on "Some Organic Laws of Memory/* by Dr.
Lay cock, in Journal of Mental Science^ July, 1875.

28 PATHOLOGY OF MIND. [chap.

instantaneous almost in its operations, and even more inventive
in sleep than during waking.

2. Impressions on a Special Sense. — Inasmuch as the senses
are not always equally deeply asleep when we are asleep, one or
other of them is sometimes so far awake as to be susceptible
to impressions ; and it is certain that such impressions may be
the occasion or determine the character of a dream. Dr.
Gregory tells how, having gone to sleep with a bottle of hot
water at his feet, he dreamt that he was walking up the crater
of Mount Etna. Though he had never visited Etna, at an earlier
period of his life he had ascended Vesuvius, and had felt a
sensation of warmth in his feet when walking up the side of
the crater. The sensation of warmth in his feet was the evident
cause of the peculiar character of his dream. There is an often
quoted stoiy of a person who, having had a blister applied to
his shaven scalp, dreamed that he was being scalped by Eed
Indians. A sound in the room or outside it which actually
awakens the sleeper may occasion or take part in a dream
which seems to have occupied a considerable time, but which
must have been over in an instant : the sound is heard before
he is actually conscious, and the mind, hastening to give some
interpretation of it, calls up probably such ideas as have been
associated with a strong or recent impression upon the waking
mind.^ Alfred Maury carried through a series of experiments
upon himself in order to test the influence of impressions made
upon him when he was asleep. He instructed a person to

^ The cerebral reception and assimilation of an impression prior to
conscious knowledge, which, when it comes immediately afterwards, is
perforce struck by it as an exactly similar former experience (see Phy-
siology of Mind^ p. 33), is a phenomenon of the same kind. In some
morbid states of the brain these illusions of former identical experiences
are very marked. In the Archiv fur Psychiatrie Dr. Pick records the
case of an insane patient sent to an asylum in consequence of excite-
ment and delusions that people put poison in his food, listened to his con-
versation, &c. "From his early years he had a vague consciousness as if
the events he was passing through had been already experienced. At first
these notions were of a dim and uncertain character, but in the course of
time they got clearer, so that he thought he possessed a double nature.
. . . Visits to pleasure resorts, the sight of public amusements, and casual
interviews with persons so affected his memory that he was convinced
he had already visited the same places and seen the same persons under
exactly the same circumstances." (Bd. vi., H. 2, p. 668).

1.] SLEEP AND DREAMING. 29

•

remain by his side and to make various impressions upon his
senses, without telling him beforehand what he was going to do,
and to awaken him soon after each impression. His lips and the
end of his nose being tickled with a feather, he dreamed that a
pitch plaster had been applied to his face and afterwards torn
away so violently as to bring with it the skin of his lips, nose,
and face. When he was pinched at the back of the neck, he
dreamed that a blister was applied to his neck ; and that
brought to his mind a doctor who had treated him in his infancy.
Other experiments had similar results, but in many of them
there was no connection to be traced between the stimulus and
the dream. Most persons must have dreamed at one time or
another that they were going about in the street naked and have
felt embarrassed or distressed at their unfortunate predicament :
it is probable that the occasion of this dream is a sensation of
cold arising perhaps from an insufficiency of clothing or from
the clothes having fallen off the bed so as to partially expose
the body. Were the sleeper in a feverish state a feeling of
chill might induce the dream without any insufficiency or dis-
arrangement of the clothes. When fever or other bodily
disturbance, such as indigestion, has produced irritation or a
disordered sensibility of the skin, as it will do, it is easy to
understand that impressions upon it will be perverted and will
be likely when they reach the brain and are translated there
into objective forms to undergo extraordinary transformations :
the least touch may become a blow, or a stab, or a bite from some
savage monster, causing the sleeper to wake up in the fright of
a nightmare.

Coleridge was of opinion that the nightmare was not a mere
dream, but that it always occurred just when the wakiug state
of the brain was recommencing, " and most often during a rapid
alternation, a twinkling, as it were, of sleeping and waking." He
supposed, in fact, that actual impressions from without enter
into and mingle with the dream images in such case and give
them an air of greater reality ; for there is at the moment a
complete loss of power to distinguish between the subjective
images and the objective realities. Without doubt this is what
happens sometimes, but whether always so \a ivoV. eet\.^\w. W.Sa»

30 PATHOLOGY OF MIND. [otap.

worthy of note, however, that in that form of melancholia in
which the insane person's mind is possessed with some vague,
vast, and horrible delusion, and he is incapable of the least exer-
tion, standing or sitting like a statue wherever he may be placed
— in which he may be truly said to be in a state of lasting night-
mare— impressions from without that are received by the senses
are perverted to suit the horrors of the delusions. The patient
has no power to distinguish between the subjective feelings arising
out of his morbid state and the actual impressions made upon
his senses ; and the anxious efforts of friends to rouse him from
his fearful lethargy, to comfort him with kindly assurances, to
sustain him with suitable nourishment which he refuses, appear
to be the malignant jeerings and tortures of devils by whom he
is surrounded and tormented. In less extreme cases of mental
derangement, the misinterpretation of actual sensations is
common enough : a perverted sensation of taste, which may be
the outcome of digestive disorder, originates or strengthens a
delusion in the morbid mind that poisonous substances have
been put into the food ; a perverted smell is thought to be pro-
duced by noxious vapours disseminated through the air; a
disordered touch suggests the play of mysterious magnetic in-
fluences. Moreover, once the delusive interpretation has been
made it reacts upon sense and aggravates the disordered sensa-
tion, just as the expectation of a particular sensation being
about to be felt sharpens the sense to feel it. These points of
resemblance between the operations of the mind in dreaming
and in insanity are of much interest, as shedding light upon
each other's phenomena ; for if we could get at the actual con-
ditions of the former it is certain we should have a valuable
clue to guide our inquiries into the darker recesses of the
latter.

3. Organic or Systemic Impressions. — There are particular
dreams which I have from time to time, and which I feel sure
originate in certain states of the abdominal viscera. I take it
for granted here that each internal organ of the body has,
independently of its indirect action upon the nervous system
through changes in the composition of the blood, a specific
action upon the brain through its intercommunicating nerve-

1.] SLEEP AND DREAMING. 31

fibres, the conscious result whereof is a certain modification of
the mood or tone of mind. We are not directly conscious of
this physiological action as a definite sensation, but none the
less its effects are attested by states of feeling tliat we are often
perplexed to account for. In truth these organic effects of the
physiological consensus of organs determine at bottom the play
of the affective nature ; its tone is the harmonic or discordant
outcome of their complex interactions ; the strength of the force
which we develop as will and the emotional colour in which we
see life have their foundation in them. This being so, it is
evident that when the external senses are shut in sleep and the
conscious operations of mind in abeyance, these internal effects
will be likely to declare themselves more distinctly, as the stars
come forth brightly when the sun goes down and they are no
longer veiled by his greater light. The sympathetic mood or
feeling aroused by a particular organ, which may from some
cause in itself be exerting a more active influence upon the
brain than is usual in sleep, will call into activity the sympa-
thetic ideas of that mood, furnishing the background on which
the appropriate dream imagery is thrown ; it will determine not
the specific forms of the ideas directly, but the ground-tone,
whether exalted or depressed, of the drama which they con-
struct— that is, the character of the dream in relation to the
personality.

It will not be disputed that we rightly discover in these
operations the occasions of many dreams ; for there are manifold
undefined changes in our systemic feeling which may well have
their different effects in dreams, though we cannot distinguish
and describe them when we are awake. When the breathing is
not free enough in sleep, and the heart's action is oppressed, as
it eventually is in such case, the sleeper is apt to wake up
suddenly in . the greatest apprehension of something terrible
being about to be done to him in his dream. The natural and
involuntary motor expression of an oppressed heart is such
action of the muscles of the face and of respiration as betokens
fear and apprehension; but this action cannot take place in
sleep, and in its stead we get an equally involuntary expi:essiQii
of the physical state in the terrifying dream au^ m >3cia i\^xi5C\^

32 PATHOLOGY OP MIND. [chap.

but bootless desire wliicli is felt to escape from the threatened
danger. For when a pjission has been aroused, or rather when
that excitation of the neiTous substrata which are its physio-
logical basis has been brought about, the energy may be expended
in one of two principal ways : either by putting in action the
muscles which are its natural exponents, or by calling up
related or sympathetic ideas and putting them in action.
Now if a person has fairly sound sleep I conclude that his
motor nerve centres and his muscular system are so much
asleep that he cannot make use of them to give expression
to his internal state in its appropriate movements, and that the
energy of it is expended mainly in the painful dream imagery.
There is a sort of inverse relation between ideas and movements
in regard to their action : when we are deeply absorbed in
thought the body is still and respiration is slower ; when we are
active and are breathing quickly we cannot think ; the insane
person whose mind is possessed with some vast and fearful
delusion is passive or statuesque ; and the ecstatic, when rapt
in contemplation, is motionless, with scarcely perceptible pulse
and respiration ; the passion that has outlet in abusive speech or
in other movements disturbs not much the thoughts ; the auger
which is suppressed calls up a host of malignant ideas. In like
manner the partially active cerebral state excited by one of the
viscera in sleep becomes the occasion of a dream, when it would
probably be discharged during waking in such simple bodily
movements as yawning, or stretching the limbs, or the like.
For there are a great many seemingly purposeless movements of
that kind that are made constantly by us, and hardly noticed
when we are awake, the stimuli of which come from the organic
life. Some such movements as moving the arms, stretching out
the legs, turning the body, we do make when we are asleep, but
on the whole ideas are then much more active than movements.
A heavy and indigestible meal taken a short time defore going
to bed is a well-known cause of a form of nightmare in which
the person dreams that he has a .mountain or a monster lying
upon his chest and crushing it by its weight. Whether the
dream be the direct effect of the action of the overloaded
stomach upon the brain or an indirect effect of the oppression

I.] SLEEP AND DREAMING. 33

of the functions of the lungs and of the heart is not easy to say,
but, whatever the actual mode of operation, it is interesting to
note how well the mental interpretation of the oppression suits
with the cause. The troubles of indigestion seldom fail to cause
a dreaming sleep. Whether the spleen ever gives a specific colour
to a dream is quite uncertain, but there can be no doubt that
disorders of the liver and of the intestines both occasion dreams
and affect their character. Every stage of the passage of food
through the alimentary canal may indeed affect the impression
made upon the brain, and the impression is thereupon interpreted,
as other feelings of subjective origin are, in accordance with the
objective experiences of the senses. I have several times had a
vivid dream that I was engaged in conducting a post-mortem
examination of a body which came to life and quietly rose up
to a sitting posture on the table as I was at work. On one
occasion I seized a wooden mallet and struck it on the head
with all my might ; on another occasion I thrust my hand
into the open chest and tore out the heart; but neither
of these desperate deeds seemed to make it die and behave
as a corpse should. On all occasions, so far as I remember,
there was the same indescribable feeling of puzzled surprise
and apprehension, with a resolution to escape at any cost
the consequences of cutting up a living body ; there was
moreover a strong sense of personal repression or humiliation
which I have never had in actual Ufe since I was at school.
This dream seems always to have occurred in connection with
some uncomfortable intestinal state : not that this had anything
to do with the special incidents of the dream, but it probably
had much to do with the fundamental feeling of self-repression
which inspired it. I am acquainted with an eminent gentleman
who, when he is suffering from a certain abdominal trouble,
dreams that he is going in distress from water-closet to water-
closet at a railway station to lind them all occupied or in such a
condition as to be unfit for use. There is an indirect way,
moreover, in which abdominal derangements help to affect
mental states in sleep — namely, through the effect which they
produce upon the skin. When there is irritation or other
disorder of the mucous membrane of tlie stomaQ\i«ixiSLm\fc^\Xxv<^^

U PATHOLOGY OF MIND. [cuap.

the outer covering of the body, with which it is really con-
tinuous, sympathises and becomes irritable and has its sensibility
affected, on which account the meaning of impressions made
upon it is more than usually perverted in dreams.

The internal organs which show their specific effects upon the
mind most plainly are the reproductive organs; the dreams
. which they occasion are of such a character as leaves no doubt
of the specific character of the stimulus. Without entering
into a detailed discussion of their phenomena, I may deduce
briefly from their striking character certain lessons which are
not so plainly taught by the more obscure eflfects of other
internal organs. In the finst place, it is a probable inference
from their characteristic effects that specific, though less striking,
effects are produced by other organs. Secondly, it may be noted
that these characteristic dreams, which appear for the first time
when the reproductive organs begin to function, occur to the
individual before there has been any actual experience of the
exercise of these functions or any observation of their exercise.
The experience is in entire accordance with the fact that there
is no need ever to teach young persons how to exercise the
functions ; the instinct giveth the understanding necessary for
its gratification. Clearly there are nervous substrata that are in-
active in every person's brain imtil he reaches puberty and which
then function for the first time. This might teach us to consider
how many peculiarities of thought, feeling, and behaviour which
differentiate us from other persons are due to nervous substrata
inherited from near or remote ancestors, some of which come
into functional action perhaps in connection with particular
bodily changes that occur at certain periods of life. The
individual who begins to feel, think, and act in accordance with
his kind when the revolution of disposition takes place at
puberty may also develop for the first time peculiarities of
thought and feeling which his forefathers have shown, when,
later in life, the functions of the reproductive organs wane or
cease. Lastly, the mental operations of these organs serve
to show of what character the effects produced by internal
organs actually are, and for what factors in mind we are
indebted to them. They engender a particular tone or feeling

I.] SLEEP AND DREAMING. 35

of mind which is conducive to the origin and activity of
certain related ideas, and they impart the force of desire by
which conduct is inspired; but they do not, as some have
supposed, directly affect the understanding, which is a function
of the animal life or life of relation, and is developed out of
sensations and motor reactions thereto, — that is, out of the
capacity to receive impressions from without and to make
responsive adaptations to them. The office of the intellect is to
guide and direct, steersman-like, the force of individuality
which is derived actually from the unconscious depths of the
organic life ; the sympathetic ideas which a particular mood of
feeling stirs are the appropriate channels or forms in which that
feeling gets expression when it is not translated instantly into
action ; and it will depend much upon the education of a
person in youth, and by the experiences of life, whether the
ideational activities shall be wise or unwise expressions of the
fundamental feeling.

I have said enough to indicate how much the physiological
action of the visceral organs has to do with the excitation and
with the character of dreaming. On the whole it is probable
that they are the most active agents in this respect ; for the
sleep of the body is not their sleep ; they continue their
functions through the niglit, albeit at a lower rate of activity;
and if the sleep be light, or if one or more of their functions be
so far deranged as to become an unusual stimulus, their cerebral
sympathies will declare themselves in the irregular activities of
dreams, when they are not so energetic as to cause waking.

4. Muscular Sensibility. — It is related of several holy persons
of old, men and women, that in their spiritual raptures or
ecstasies they rose bodily from the earth and floated in the air ;
and there can be small doubt that some of them felt and believed
that they did. St. Philip N"eri, St. Dunstan, St. Christina could
hardly be held down by their friends, while it is told of Agnes
of Bohemia that, when walking in the garden one day, she was
suddenly raised from the ground and disappeared from sight of
her companions, making no answer to their anxious inquiries
but a sweet and amiable smile on her return to earth after her
flight. Everybody must at one time or another have had a

36 PATHOLOGY OF MIND. [chap.

similar experience in his dreams. The explanation is not far to
seek : a person may have a motor hallucination, so to speak, and
imagine he makes the movement which he does not, just as he
may have a sensory hallucination and imagine he sees or hears
the thing which he does not. We are the victims of motor
hallucinations when we suffer from what is called vertigo and the
room seems to turn round ; the intuitions of movements which we
get from the disordered action of the motor centres, and which
therefore are entirely subjective, are interpreted objectively in
accordance with our ordinary sensory experience, just as sensa-
tions of subjective origin are interpreted objectively, and so
become hallucinations. Certain drugs when taken into the
blood produce vertigo at an early stage, and perhaps convulsions
at a later stage of their operation"; they afifect the motor and
associated sensory centres moderately in the first instance,
exciting them to a disordered activity, the subjective aspect
of which is vertigo, and afterwards more severely, when the
disordered energy is discharged in actual convulsions. The
drunken person when he shuts his eyes feels the bed to sink
under him, the disorder of his motor intuition being interpreted
objectively in that way, and when he falls on the ground or
runs his head against the wall he perceives the ground to rise
and strike him, or the wall to run forward against his head :
his motor troubles and hallucinations are the direct consequences
of the poisoning of his nervous centres by alcohol. One of the
effects of aconite, when taken in poisonous doses, is to produce
a feeling as if the body were enlarged or were in the air, mainly
perhaps in this instance because of the loss of sensibility of the
surface of the body which is an effect of the poison, whereby
the person does not feel himself in contact with what is outside
him ; the part of the body from which he gets no message when
it is touched appears therefore to be no longer his, and he
interprets the interruption of feeling between him and the
outside objects as an actual separation of substances such as
would be produced by the body being in the air. These
examples will serve to indicate how considerable a part motor
hallucinations, combined as they commonly are with sensory
disturbances, may play in the phenomena of dreaming.

1.] SLEEP AND DREAMING. 37

An uncomfortable position in which the sleeper may chance
to lie becomes the occasion sometimes of a dream that he is
engaged in a desperate struggle, or is clambering for very
life up a steep precipice, and when he has made the convulsive
effort to save himself, which he feels that he cannot probably
do on the instant, he awakes and relieves the constrained attitude.
A not uncommon dream is that he is in imminent danger of
falling from a height, and he awakes just as he makes the
frantic effort to prevent himself from falling. It has been sur-
mised that this dream is owing to the gradual relaxation of
the muscles as he goes to sleep and to an ensuing sudden
contraction of them, such as we observe to happen when a
person's head who is very sleepy sinks gently forwards as the
muscles relax, and then is pulled suddenly up with a jerk by
their contraction ; or it may be owing to the inclined position
of the bed on which the body is lying. After great muscular
exertion in climbing high mountains I have often dreamed of
sliding down precipices, falling into chasms, and the like, and
that so vividly sometimes as to be obliged, on waking, to stretch
out my hands and grasp the sides of my bed before I could feel
sure where I was ; without doubt the wearied muscles were the
occasion, through then* motor centres, of the mental drama in
which the sensory experiences of the day were worked up. But
I was once surprised to dream this sort of dream when I had
been making no particular muscular exertion in the day, nor
had been near any mountains, and when I could at first think
of nothing which could have provoked it ; on reflection, however,
I called to mind a momentary experience of the day which
seemed to be a sufficient cause ; for I had been driven rapidly
in a waggonette to a railway station in the country, and as the
horses turned a corner of the road as we went downhill, my
muscles contracted involuntarily because I felt from the swing
of the carriage a necessity to hold on to the seat. There could
be no doubt that this momentary feeling of a support failing
was the occasion of the night's dream. When Braid roused in
the minds of persons whom he had put into the hypnotic sleep
ideas associated with certain bodily attitudes by putting the
body into the proper attitudes, he stimulated the mental states

38 PATHOLOGY OF MIND. [cbat.

through their suitable muscular acts ; he might no doubt have
excited them equally successfully without any muscular action by
suitable stimulation, had it been possible, of the motor centres
only; exciting in this way the motor intuitions without the
actual movements, just as is done when delusive notions as to
different positions of an amputated limb are excited by stimu-
lation of its nerves. There can be little doubt that what Mr.
Braid did experimentally in artificial sleep is a common occur-
rence in natural sleep, and ought to be t^ken account of in
prosecuting inquiries into the causation of dreaming.

It may be interesting to speculate whether the movements of
the heart and of respiration, which go on without intermission,
and with only some abatement of energy, during sleep, have
any effect upon dreams. That they have no such effect when
they are not accelerated or retarded is proved by the fact,
if it be a fact, that sleep is sometimes dreamless ; but there is
good reason to think that when they are disordered they testify
of themselves in dreams. On several occasions I have had a
dream in which I felt it urgently necessary to make an instant
exertion in order to go on living, having experienced a vivid
and urgent feeling that if I did not make it I should die ; and
although I have resolved after such a dream to ramain quite
still when next I had it, in order to test what would happen, I
have never yet succeeded ; so overwhelming is the apprehen-
sion at the time, that the necessary convulsive start or gasp has
always been made, and I have awoke in a state of agitation
with my heart beating tumultuously. The dream seems to have
its origin in an impeded action of the heart, which, after en-
during the oppression for a while, makes a violent beat to recover
itself, and then goes on beating rapidly for a time. It may be
presumed that a more rapid action of the lungs and of the heart
than usual, or the ordinary action of these organs perhaps under
some circumstances, will be felt by the brain during sleep, and
so give a character to the ensuing dream. What this character
is I am not able to say, unless there is truth in the conjecture
that the sensation of flying in dreams is owing to a consciousness
of the rhythmical activity of the lungs or of the respiratory
movements, which suggests the rhythm of flying movements;

1.] SLEEP AND DREAMING. 39

but that we have in these continuing movements occasional
factors in the production of dreams is in accordance with general
physiological considerations, and with such positive experience
as we can appeal to in so very obscure a matter.

5. The Cerebral Circulation. — When the brain is thinking
there is a moi^e active flow of blood through it than when it is
at rest ; but this flow must not be too active, or sound thinking
cannot be done. There are two conditions which experience
proves to be adverse to successful thought — namely, an excessive
and a deficient flow of blood through the brain. There may be
an excess of blood in the brain, however, with a retarded circu-
lation, a passive congestion, which equally hampers thought, as
it prevents the free outflow of vitiated blood and the free inflow
of fresh blood. When the circulation is too active the ideas are
rapid, imperfect, transitory, tumultuous, confused, and scarcely
coherent; and if the physical disturbance be carried a step
further, the tumult of ideas degenerates into actual delirium, as
we plainly observe, for example, when the membranes of the
brain are inflamed. When there is too little blood or impover-
ished blood flowing tlirough the brain, thought is also impeded :
there is languor, apathy, incapacity of concentration of attention,
positive inability to think ; and if the condition of physical dis-
turbance be aggravated, then also there is delirium, though of a
looser, more feeble, and less energetic kind than the delirium
of hypersemia. Applying these considerations to the state of the
cerebral circulation in sleep, it is easy to understand that fluc-
tuations of it will oftentimes be the occasion of dreams. Notably
these are sometimes very vivid and coherent ; the sleeper awakes
perhaps out of a dream which seemed very real, goes to sleep
again, and is immediately engaged in another equally vivid,
which leads to his waking again ; no sooner is he asleep once
more than he is in the middle of another vivid dream, and as
dream thus follows dream in quick succession, making a curse
of slumber, he might well exclaim in the words of Job — " When
I say, my bed shall comfort me, my couch shall ease my com-
plaint ; then thou scarest me with dreams, and temfiest me
through visions."

Tt is a probable conjecture that these vwid aivQi e.o^^t^'iJi^

3

E

^ T

I

10 PATHOLOGY OF MIND. [t

dreams mark a general activity of the cerebral circulation,
nd that they follow one another aa long as it continues.
The misfortune is that in this condition cause and effect
seem to act and react so as to keep up each other's activity :
the full or rapid blood-stream stinmlatea the nerve-elements,
and the excited nerve-elements in turn attract and keep up an
active circulation : we could sleep soundly if the stream of blood
would only subside, and the stream of blood woidd subside ii'
we could only abate or suspend the race of ideas through the
mind. Meanwhile neither will begin to abate first. Tlie merit
of the several plans which have been recommended as success-
ful means of inducing sleep lies in their fixing attention steadily
upon some object or event that is itself of an unexciting nature
for a sufBcient length of time to allow all active ideas to subside.
To imagine a continuing monotonous sound, or a flowing river, or
the rush of a stream of steam from the nostrils, and to hold the
attention to the particular imagination without permitting it to
wander to more exciting ideas, to repeat to oneself slowly lines
of poetry, or to go on counting from one upwards, and the like,
are all schemes which operate in that way ; and in canying
them into effect success will certainly be more probable, accord-
ing to my experience, if the breathing be deliberately slackened
and the eyeballs rolled upwards voluntarily, as is done in-
voluntarily during sleep,

Ijocal fluctuations of the circulation may in like manner be
supposed to be the causes of dreams more limited in range and
less coherent in character. Certainly such variations occur,
although we are not able to specify the exact causes of them.
Looking, however, to the many ingoing channels of communica-
tion between the different organs of the body and the brain in
which they are all represented locally, it is easy to conceive that
some trivial disorder of one of them may affect temporarily,
through vaso-motor nerves, the circulation in tlie cerebral area
in which it is represented : the particular vascular area will
blush or become pale, as it were, in sympathy with the state of
the organ. Baillarger relates a case which may find a place
here as fitly as anywhere else, A Greek merchant had suffered
for a long time from a hfemorrhoidal fiux, which was suppressed

SLEEP AND Di!EAMING. ^

at last by treatment. But he begstn immediately to suffer jtniuB
in hia head, without however exhibitiog any trace of delirium.
A singular phenomenon too presented itself : eveiy niglit he
Lad a dream in which he imagiued that he possessed immense
wealth, and that lie distributed fortune and honours to all around
him. The recurrence of the dream night after night struck hira
as so extraordinary that he spoke about it to his friends,
a short time delirium broke out, characterised by the same coi
ceptions aa for fifteen days had occurred during sleep : in ft
the exalted delirium was only a continuation of the dream.
may be surmised that in this case there was, in consequence
the suppression of tiie hemorrhoidal flux, a disturbance of
cerebral circulation which showecl itself firat in the troubles of tl
Lead and afterwards in the dream of the night, and that the
cular distai-bance, with the special cerebral activity accompany"
ing it, became after a time a chronic and permanent dernngemeni
The quality of the blood is a not less important factor tliai
the quantity and the distribution of it. Foreign matters bred
it or introduced into it from without increase, lessen, or pervert
the functions of the supreme cerebral centres, giving rise to
temporary exaltation of mental euei^y, to stupor and coma, and
to delirium. The constant changes in the constitution of the
blood, which are the consequences of its use and renewal in tl
nutrition of the tissues, its life-history being a continued me(
stasis, will undergo such modifications from time to time as
generate substances that may act upon the nerve-centres,
upon other tissues of the body, to excite or to depress or
derange their functional activity ; and it is obvious that the ciiv'
culation of such products in the blood may be the active occasion
of dreaming. Blood that is impoverished through deficiency of
one of its essential constituent elements, as in aniemia, where
iron is wanting, or is impure by reason of the retention in it of
some effete products of the tissues which should be excreted, as
when hindered respiration prevents it being properly decar-
bonised, or when some constituent of the bile accumulates in it,
or when the uric acid which should be drained ol? by the Jddneya
is retained in it, may he confidently expected to act upon the
brain in sleep as powerfidly as it does when awake.

md

the ^^m

m

«

42 PATHOLOGY OF MIND. [chap.

I^t it not Ve overlooked in relation to this matter that the viti-
ated or altered blood will act upon any nerve-centre, whether
sensory, motor, vaso-motor, or ideational. Subjective visual sensa-
tions, such as bright spots, circles of light, coloured patches, vague
figures, that are due to direct irritation of the retina or its central
ganglion, and which may be observed almost always just before
going to sleep, if we only take notice of them, will originate a
dream or be woven into it ; motor intuitions will be excited in
like manner by the action of the vitiated blood upon their
nerve-centres ; it will act again upon the vaso-motor centres
which regulate the contraction of the blood-vessels, and so affect
secondarily the circulation within the brain ; and by reason of
its distribution through the supreme nerve-centres it will stimu-
late ideas mechanically, independently of the usual links of
association, and so probably occasion very incoherent dreams
marked by rapid transformations and grotesque inconsistencies.

Dreams are sometimes found to go before a severe bodily illness,
which they seem to foretell : before the delirium of fever breaks
out the patient is much disquieted and distressed by vivid and
gloomy dreams, of which the delirium appears as a continua-
tion ; and during the progress of fever, when he is not actually
delirious, all inclination to sleep is banished, though he would
give all he has to get sleep, painful thoughts chase one another
in rapid succession through the mind, and he is overwhelmed
with a terrible feeling of profound depression and vague dread,
the indescribable misery of which he declares he would not choose
to go through again for all that the world can give. Did tlie
invention of hell need any explanation the mental sufferings of a
delirious patient in some instances might furnish it. An out-
break of acute mania of an elated character is sometimes pre-
ceded by dreams of a joyous and elated character, and sad and
gloomy dreams in like manner often go before and presage an
attack of melancholia. I was consulted on one occasion by a
lady who had suffered from several attacks of profound melan-
cholia, each of which had lasted for about four months ; they
were separated by longer intervals of sane and busy cheerful-
ness, during which she was 9.S unlike as possible what she was
when she was afflicted. The notable circumstance in her case

1.] SLEEP AND DREAMING. 43

was that before an attack she iuvariably dreamed that she was
sufifering from it, and before it passed off as invariably dreamed
that she had recovered and was cheerful and well. So certain
were these dream-presages that they had never failed to occnr
and had never deceived her. And yet she did not feel more
cheerful just before she recovered, nor more energetic imme-
diately after her recovery ; on the contrary, for two or three
days before the attack passed off she was more wretched than
ever, and far more irritable, so that she was inclined to smash
everything about her ; and immediately after it passed oJBf she
was exhausted, felt very feeble, and was unable to make the
least exertion. Before the attack there always occurred ex-
actly the same symptoms of digestive disorder, which no kind
of treatment — and many things had been tried — assuaged in
the least : the tongue became remarkably red, she could take
little or no food, and there was obstinate diarrhoea. The symp-
toms no doubt pointed to a primary affection of the great sym-
pathetic nervous system, which was followed in a little while by
cerebral disturbance ; and it would certainly appear that the
brain felt the sympathetic trouble in sleep, and so forefelt and
foretold the impending calamity in its dreams, before it had
waking consciousness of it, just as in like manner it forefelt and
foretold recovery.

I know not certainly whether the state of the blood has any-
thing to do with the dreaming which occurs in connection with
certain diseases, but it is probable enough in some cases. The
inquiry is one which may be set down as having yet to be made.
All that we are meanwhile warranted to conclude positively is
that the quality of the blood is a real factor in the stimulation
and depression of the cerebral and other nerve-centres, and
therefore. in the causation of dreaming. It may act directly or
indirectly to produce its effect: directly upon the supreme
cerebral centres so as to excite irregular function in them, or
directly on the sympathetic nervous system, and indirectly on
the brain, whereby a deep disturbance of the affective nature is
produced and gives its predominant tone to the dream.

6. The Condition of the Nervous System. — Little considera-
tion is needed to show how difficult it must be to treat of the

44 PATHOLOGY OF MIND. [cbap.

condition of the nervous system separately from the qnality and
activity of the blood ; in truth, they constitute together a com-
pound state rather than distinct co-operating conditions. The
vital interchanges between the blood and the nerve cell which
are constantly going on are an essential part of the function of
the latter as a living cell ; without them it could not exercise
any function at all, being in itself a sort of mechanical frame-
work which is kept in action by the plasma supplied from the
blood that it uses and exhausts in its function ; it feels therefore
the least changes in the quality of the supply. But the structure
itself wears out in time ; it wears out naturally with the decay
of old age, and it will wear out prematurely if an undue stress be
put upon it habitually. The blood has not only to supply in the
rich plasma the high potential force which is to be made actual
energy in the discharge of nerve-function, but it has to keep in
repair the nerve-structure ; and this it must fail to do when the
latter is subjected continuously to an excessive strain. Because
then of the deterioration which may be produced in nerve-
elements by stress of function as well as by natural decay, and
because also of temporary modifications of nerve-tone which
seem to be produced by unknown atmospheric conditions, I
have thought it fitting to group the facts relating to the direct
state of the nervous system under a separate heading.

A state of moderate nervous exhaustion, whether from the
fatigue of mental or bodily exercise or from some other cause, is
notably most favourable to the induction of sleep. But when
the exhaustion is carried to excess the propitious conditions are
gone, and the person cannot sleep at all, or cannot sleep soundly :
he may get fitful snatches of unrefreshing slumber in which he
is pursued by dreams that are so like the rambling incongruities
of half-waking fancy as to leave him in doubt, whether he
actually slept or not. It is a well-known experience that a
moral shock or a great trial which has produced much emotional
agitation or strain in the day will trouble the slumbers of the
night with distressing dreams ; and it is equally certain, though
it is perhaps not so well known, that an exhausted and depressed
state of the nervous system owing to indulgence in excesses of
any kind, and especially sexual excesses, will have the same

1.] SLEEP AND DREAMING. 45

effect. The dreams which occur under these conditions betray
their origin by their character. They are disagreeable or dis-
tressing dreams of being encompassed by difi&culties or troubles
of some kind or other — the exponents of a condition of organic
element which means a reduction of its vitality. For a moral
strain or a physical excess is able to produce the same physical
effects in the cerebral nerve-centres — namely, consumption of
energy and lowered vitality ; and the lowered vitality becomes
in dreams an oppression or a check or a humiliation of self,
just as a bodily pain which we are suffering when we go to
sleep becomes transformed sometimes into the persecutor of our
dream. We cannot be too mindful of the physical effects of
moral causes ; a moral shock may kill as instantly and surely as
a stroke of lightning, and when it does so its operation and
effect are as certainly physical in the one case as in the other.
Nor can we be too mindful of the effects of exhausting physical
conditions upon mental tone and power.

Whosoever is so unhappy as to have habitually sleepless nights
and bad dreams should bethink him that his health requires
attention ; for in some way or other he is not living wisely. A
prudent man will indeed use his dreams as a sort of health-gauge.
When Hamlet declared that he could live bounded in a nut-
shell and count himself a king of infinite space, were it not that
he had bad dreams, he was suffering from the great moral com-
motion produced by the appalling revelation of his father's
murder, which his father's ghost had made to him, and from the
terrible strain of the obligation laid upon him to avenge that
crime ; his dreams — if we may take him to mean literally what
he said — were the signs and the effects of an exhaustion of
nervous energy which might, have overthrown a less strong mind
in madness. Over-work and anxiety are well-known causes of
sleepless nights and bad dreams ; but in some cases of supposed
over-work I am convinced that the evil result which excites
alarm is owing not so much to overstrain of mind as to im-
prudent excess in other respects. The over-indulgences of life
are really more to blame in such cases. The man of business
goes through the daily routine of his work with no more variety
of impressions than is occasioned by an extra cause of worry or

46 PATHOLOGY OF MIND. [chap.

by a chance stroke of good or ill fortune ; he has no interests
outside it, and when he is not occupied in it he has no resource
but to eat and sleep ; probably he eats grossly, drinks freely,
and is not less free in sexual indulgence ; and this goes on from
day to day and from year to year until, as the elasticity of the
system wanes with advancing manhood, he has to seek advice
from a physician because his sleep fails him, his work tries him
as it never used to do, he is irritable, and he feels overworked.
It is from sensual indulgence and the exhaustion consequent
thereupon, and from a neglect of mental hygiene, that he suffers
primarily ; the work of his life might have been done without
strain if he had not exhausted his capital by the steady drain of
habitual slight excesses, and so made a great burden of his daily
duty. But I will not pursue these matters further now ; I have
touched upon them by the way only to make plain the similarity
of results as regards sleep and dreaming between the effects of the
moral and the physical causes of exhaustion of nerve-element.

When the nervous structure undergoes impairment in old
age, the decay is natural, and I know not that the dreams of old
persons are particularly distressing. ITie decay of age is n6t,
like a disease, an invader against which the organic forces rise
in defence, and defend themselves with more or less success ; the
organism acknowledges and accepts it rather as a natural decline
that makes its descent to death easy. What we observe in old
age is that the distinction between sleep and waking is less
marked than in youth and manhood, both being less com-
plete: nature as it approaches its last sleep is fashioned for
the journey. When decay reaches its last stage before death,
and life is flickering before it expires, there are rambling reveries
which are very like dreams, and dreams that show like feeble
delirious wanderings. Lord Jeffrey, in the last letter which he
wrote the day before his death, gives the following account of
himself : " I don't think I have had any proper sleep for the
last three nights, and I employ portions of them in a way that
seems to assume the existence of a sort of dreamy state, lying
quite consciously in my bed with my eyes alternately shut and
open," and seeing curious visions. He saw part of a proof-sheet
of a new edition of the Apocrypha, and all about Barach and the

I.] SLEEP AND DKEAMING. 47

Maccabees, aud read a great deal in it with much interest ; and
a huge Califomian newspaper full of all manner of old adver-
tisements, some of which amused him much by their novelty.
" I had then prints of the vulgar old comedies before Shakespeare's
time, which were disgusting. I could conjure up the spectacle
of a closely-printed political paper filled with discussions on
free-trade, protection, and colonies, such as one sees in the
Times, the Economist, and the Daily News. I read the ideal
copies with a good deal of pain and difficulty, owing to the
smallness of the type, but with gi*eat interest, and, I believe,
often for more than an hour at a time ; forming a judgment of
their merits with great freedom and acuteness, and often saying
to myself: ' This is very cleverly put, but there is a fallacy in it
for so and so.' "^ The literary pursuits of his life gave their
character to the flickering energies of his failing nervous centres,
and the critical habit of his mind showed itself in its final
operations.

The dreams of childhood are sometimes of a painful character,
being accompanied by great terror and distress. The most
terrifying dream which I remember ever to have had, which
made me most unhappy for a whole day and fearful of going to
bed the next night, and the chief incident of which I can yet
recall, was one which I had at the earliest period of life almost
of which I have any recollection. Without doubt the causes of
most of these dreams of childhood are to bo found- in the bodily
disturbances which are produced by teething, indigestion, un-
suitable food, and the like : the bodily oppression or suffering is
interpreted mentally in such forms of terror and affliction as
the child's imagination has been indoctrinated with, and it is
accordingly scared with visions of lions or tigers, or wicked old
men that come to carry off naughty children. The emotional
life preponderates much over the intellectual life in children,
who are commonly either in a state of joy or grief, laughing or
crying ; they are consequently very susceptible to fear, just as
savages are ; indeed it can hardly be otherwise when their
individual helplessness is in such strong contrast with the
seemingly mighty powers of things around them, and when they

* Jeffrey's Life and Corres])ondence, by Lord Cockbiirn, vol. i. p. 407.

48 PATHOLOGY OF MIND [chap.

have not in their minds stored up experiences to enable them
to correct or control by reflection the present image of terror,
which furthermore acquires in dreams an extraordinarily vivid
intensity because of the absence of all distracting or modifying
states of consciousness. We witness a striking illustration of
the isolated intensity of a terrifying dream-image in that form of
nightmare in which a child of a nervous constitution shrieks
out in the greatest apparent distress, staring wildly at some
imaginary object, and from which it cannot be awakened for
some time notwithstanding its outcry ; it is truly in an ecstasy
of terror ; there is a convulsive activity of the terrifying idea,
and for the time the nervous centres are entirely insusceptible
to other impressions. In the morning the child has not the
least remembrance of what has occurred : how should it remem-
ber when the mental state was isolated by its convulsive energy ?
Another circumstance to be noted about dreaming children is
that they often talk in their sleep, the ideas being translated
into movements of speech directly as they arise, or, if they are
of a terrifying character, into cries of distress ; in the same way
horses neigh and kick, and dogs bark and tremble, in their sleep.
It is probably in some sort a consequence of this direct reflection
of ideas into movements in children and of the fewness of their
ideas that they seldom remember their dreams ; and it is interest-
ing to note in this relation that there are some grown-up persons
who when they talk much in their sleep cannot remember their
dreams, but remember them perfectly well when they do not
talk.

Concerning the atmospheric conditions, whether of electrical
or other obscure nature, which may modify the tone of the nervous
system and so affect the soundness of sleep and the tendency
to dream, there is nothing more to be said than that an influence of
the kind is very probable, although we have not yet any exact
knowledge of it. Systematic observations are entirely wanting.
I am not aware that any one has yet been at the pains to make
a long series of observations of his sleep and dreams and to
compare it with a corresponding series of meteorological observa-
tions. But I doubt not from my own experience that we do
vibrate in unison with more subtle influences of earth and

I.] SLEEP AND DBEAMING. 49

sky than we can yet measure in our philosophy.^ Dreams
have heen a neglected study ; nevertheless it is a study which is
fuU of promise of abundant fruit when it shall be earnestly
undertaken in a painstaking and methodical way by well-trained
and competent observers. To physicians of all men is it likely
that they will prove full of instruction.

* How great is the effect upon some persons, both in the day and in
the night, of that oppressive state of the atmosphere which precedes and
accompanies a thimderstorm I I have thought sometimes that the brain
of an aged person, who has led a life of great activity — perhaps never
having had a day's illness, as it is said — has collapsed suddenly in such
atmospheric conditionSb

CHAPTER IL

HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES.

Under such names as mesmerism, animal magnetism, electro-
biology, hypnotism and braidism, have been described, and
more or less carefully investigated, certain abnormal mental
states, of a trance-like nature, which are induced artifically by
suitable means. Too long they were rejected as sheer impostures,
unworthy of serious study, partly because they undoubtedly
yielded easy occasions to knaves to practise deceit for their
pleasure or their profit, and partly because they seemed to be
inconsistent with known physical laws. Had the interpretation
given of them by those who were eager to discover something
marvellous been the only possible one, there would certainly
have been a blank contradiction of known physical laws. But
it was not so ; when close and critical attention was given
to the phenomena it was soon perceived that they might
be genuine, though they were interpreted wrongly; and the
scientific study of them, imperfect as it yet is, has shown that
they are consistent with certain other obscure nervous phenomena,
and has been useful in throwing some light upon the manner of
working of nervous functions. A good use of uncommon things
is to force us to look more curiously at the meaning of common
things which we overlook habitually. These abnormal phe-
nomena have not yet, it is true, been brought under the domain
of law, because we have not sufficient knowledge of the exact
conditions of their occurrence to enable us to define the laws
which govern them, and because their changeful, irregular, and
seemingly capricious and lawless character puts great difficulties

V w to w k> «

■^4. ^«'*'W * •»to».

CH. II.] HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES. 61

in the way of systematic inquiries ; but it is not seriously dis-
puted now that they will ultimately have their proper place in
an orderly and complete exposition of nervous functions.

When a person was thrown into this sort of abnormal mental
state by the influence of another person upon him, the question
was whether the effect was due to some subtle and unknown
force that emanated from the nervous system of the operator
and was transmitted to the person operated upon, or whether it
was due to the excitement of the latter's imagination — in other
words, to the condition of extraordinary activity into wliich his
nervous system was brought. Those who were eager that
strange and mysterious phenomena should have extraordinary
and mysterious causes hastened forthwith to invent new forces
which they called mesmeric, magnetic, odylic, and the like ; they
were loath to believe that they had to do only with phenomena
which, though strange and abeiTant, might yet be referred to the
operation of known causes, and to search patiently whether there
were not other phenomena, neglected because less striking, with
which they might be compared and classified. The inquiry, had
it been carefully and candidly made, would have shown that
they were extreme instances of the operation of known laws.

Let us go on to consider then what these abnormal phenomena
are and how they are produced. After being induced to look
intently at the operator, or so-called magnetiser, who attracts his
attention by making a few gentle passes with his hand, or by
holding some bright object before his eyes at a little distance
from them, or by merely looking fixedly at him, after a short
time the person operated upon falls into a trance-like state, in
which the ordinary functions of his mind are suspended, his
reason, judgment, and will being in complete abeyance, and he is
dominated by the suggestions which the operator makes to him.
He feels, thinks, and does whatever he is told confidently that he
shall feel, think and do, however absurd it may be. If he is
assured that simple water is some bitter and nauseating mixture
he spits it out with grimaces of disgust when he attempts to
swallow it ; if he is assured that what is offered to him is sweet
and pleasant, though it is bitter as wormwood, he smacks his
lips as if he had tasted something pleasant; if he is told

52 PATHOLOGY OF MIND. [chap.

that he is taking a pinch of snuff when there is not the
least particle of snuff on his finger, he sniffs it and instantly
sneezes; if warned that a swarm of bees is attacking him
he is in the greatest trepidation, and acts as if he were
vigorously beating them off. The particular sense is dominated
by the idea suggested to the mind, and he is very much in the
position of an insane person who believes that he smells dele-*
terious odours, tastes poison in his food, or is covered with
vermin, when he has the delusion that he is afflicted in one
or other of these ways ; or in the position of the dreamer who is
entirely under the dominion of the imaginary perception of the
moment, however extraordinary, ludicrous, or distressing it may
be. He will in vain make violent and grotesque exertions to
lift his arm or his leg when he has been confidently told that he
cannot do it. In no case could he do this if he had not the
belief that he could do it, and he is impotent therefore to do it
when he has the strong belief that he cannot do it : the growth
of a child's doings is the growth of its beliefs that it can do.
His own name he may know and tell correctly when asked to do
sa, but if it is affirmed positively to be some one else's name he
believes the lie and acts accordingly ; or he can be constrained
to make the most absurd mistakes with regard to the identities
of persons whom he knows quite well. There is scarcely an
absurdity of belief or of deed to which he may not be compelled,
since he is to all intents and purposes a machine moved by the
suggestions of the operator. It is interesting to note, however,
that he will not commonly do an indecent or a criminal act; the
command to do it is too great a shock to the sensibilities of the
brain, and accordingly arouses its suspended functions. The
sensibilities of the different senses, or of one or more of them,
may be exalted, but at other times they are abolished, the con-
dition being very much that of complete trance, and the
insensibility so great that the severest surgical operations have
been performed without eliciting the least sign of feeling.^ When
the person comes back to a state of normal consciousness the

' In 1859 two eminent French surgeons, Velpeau and Broca, performed
surgical operations upon twenty-four women who hud been put in the
hypnotic state by Braid's method, without pain.

11.] HYPNOTISM, SOMNAMBULISM, AND ALLIED STATEa 63

illusions disappear instantly, his senses recover their natural
sensibilities, and his mental faculties resume their suspended
functions ; but in some cases a little time must elapse before he
regains his natural control over himself, and it will be more easy
to throw him into the abnormal state on another occasion.

The conditions of the induction of the abnormal state of
consciousness seem to be, first, a nervous system that is more
than usually susceptible and unstable, and, secondly, the exercise
of a fixed and strained attention for a short time. With regard
to the first condition. Baron Keichenbach, w^ho was a sincere
believer in the action of a special force, which he called odic
force, gives testimony which is the more instructive here because
it comes from one who saw in the phenomena something more
than natural nervous function. " I inquire," he says, ** among
all my acquaintances whether they know any one who is
frequently troubled with periodical headaches, especially megrim,
who complains of temporary oppression of the stomach, or who
often sleeps badly without apparent cause, talks in the sleep, rises
up or even gets out of bed, or is restless at night during the
period of full moon, or to whom the moonlight in general -is
very disagreeable, or who is readily disordered in churches and
theatres, or very sensitive to strong smells, grating or shrill
noises, &c. All such persons, who may be otherwise healthy, I
seek after and make a pass with my finger over the palm of their
hands, and scarcely ever miss finding them sensitive." Nine
out of ten of his " sensitives " he found to be females *' or youths
of the same nervous temperament," the majority of them under
twenty-five years of age, and they all seemed to have inherited
their sensitiveness from their parents. Obviously then a certain /
neurotic temperament is most propitious to the induction of
the mesmeric or hypnotic state. The second condition is the *
fixation of the attention for a short time through sight. Mr
Braid used to make the person look upon a disc or some bright
object held in front of and a little above the level of the eyes
but the operator commonly looks him in the face and makes a
few gentle passes with his hand before his eyes ; after a little
while there is a tremor of the eyes, the pupils dilate, and he
falls into the mesmeric state. All that the Abb^ Faria, a

64 PATHOLOGY OF MIND. [chap.

successful mesmeriser, used to do was to look fixedly at his
subjects in an impressive manner and to say in an imposing
voice, " Sleep," when they instantly fell asleep.

It was long known to jugglers, and two hundred years ago it
was shown by a Jesuit priest, Kischer, who attributed the effect
to magnetism, that if a cock or a hen be grasped firmly in the
hands and held fast for a short time with its beak on the ground,
a chalk line being drawn straight from the beak so that its eyes
converge upon it, it remains there fixed, motionless, and more or
less insensible ; so much so as not to feel even the pricks of pins
that are thrust into its body. It is in a state of hypnotic sleep.
The chalk-line is not really necessary; the simple handling
or holding of the hen usually suffices to produce the effect,
Morever, as Czermak showed, the experiment may be done
successfully on other animals — on young lobsters, frogs, geese,
ducks, and even on dogs sometimes ; the help of an object to
gaze at being necessary in some cases. Something of the same
kind occurs, I believe, when a cat fascinates a bird so that it
cannot make the least exertion to escape, or actually drops from
I its perch into the paws of the cat We perceive then that by
' giving a particular strain of fixed activity to the nervous system
I its ordinaiy functions may be suspended, and it may be made
'- insensible, so long as the isolated activity continues, to the
impressions which ordinarily affect it. What is the intimate
change in the nerve-element which produces this state of non-
conduction between associated nerve-centres, this discontinuity
of function in spite of continuity of connecting fibres, we know
not ; it must suffice for the present to know that a particular
form of activity is capable of reaching such a pitch as to suspend
or inhibit, while it lasts, the ordinary functions of the nervous
system, and to know this furthermore by instances in which the
supposition of a transmission of any peculiar force from the
operator to the creature operated upon may be confidently rejected.
The mesmeric or hypnotic subject who is for the moment
entirely under the sway of the idea suggested by the operator and
insensible to other impressions is in a similar condition of par-
tial activity and general incapacity of cerebral function. If we
reflect, we may call to mind gradational states between this

II.] HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES. 55

abnormal form of activity and the entirely noniial exercise
of mental function. Take, for instance, the state of profound
reverie in which the brain is so earnestly engaged in an
absorbing reflection, so completely abstracted thereby from the
usual paths of function, as to render the greater part of it
insusceptible to impressions, and the individual therefore un-
conscious of what is going on around him : sounds strike his
ear and he hears them not, incidents happen around him and
he notices them not, the pain of disease may be unfelt in the
deep abstraction of his mind from it. There is a track or an |
area of activity lit up by consciousness, while all around are 1\
darkness and inactivity. Without falling into this Archimedes- \
like abstraction, any one may notice that when he is reflecting
earnestly on a subject in which he is deeply interested he is
scarcely conscious ; it is only the lapses of his attention that
make him conscious ; and the same period of time will appear
to him as a minute or an hour according as he is deeply
absorbed in his subject or not An acute pain notably renders
us insensible to a less pain, though the conditions of the latter
continue in operation ; the message sent to the central ganglion
by it no longer awakens any notice, for there is a local suspension
or inhibition of its sensory functions in consequence of the
abstraction of consciousness by a neighbouring predominant
activity. In the same way a severe neuralgia may be replaced
by convulsions, itself ceasing when they come on, and may
return when the convulsions stop, the disordered energy being
transferred, as it were, from one class of nerve-centres to another.
In the excitement of battle a wound is not perhaps felt at the
time of its infliction, and some animals like frogs and snails
are insensible to pricking or cutting during the act of sexual
copulation: in all animals indeed the acute sensory orgasm
is incompatible with any distraction of thought or feeling, and
silences for the moment of its transport any pang of bodily pain
which there may chance to be. No better example than this
from the physiological life could be given to illustrate a mode of
nervous function which is exhibited pathologically in certain
forms of hysterical ecstasy. The quasi-cataleptic and almost
insensible state of the melancholic patient whose mind is

56 PATHOLOGY OF MIND. [chap.

possessed with one terrible delusion which will not let it go,
and the real cataleptic, whose limbs retain for an indefinite
period whatever position may be given to them while he is
insensible to outward impressions, seem to be examples of the
same mode of function.

Many more instances might be mentioned of this kind of
induced discontinuity or disruption of mental function in
the supreme cerebral centres. If a nervous person coming to an
anxious interview with a superior is asked abruptly and harshly
what his name is, he may clean forget it, just as a nervous
student at an oral examination may be unable to answer a
question the answer to which he knew quite well a minute
before, and will know quite well a few minutes afterwards.
He is like the hypnotic who when he is told that he cannot
pronounce a certain letter boggles and makes futile attempts
at its pronunciation, but at the same time pronounces it
unconsciously in the very words which he uses to declare
that he cannot do it. How often shall a confident brow and
a bold assertion carry temporary conviction to a mind
which is struggling all the while to resist belief, and which
is able, only by quiet reflection afterwards, to reassert its
independence and judgment ! Nervous and hysterical persons
may be made to believe almost anything that a person to
whom they have yielded their confidence, and who has un-
bounded confidence in himself, affirms to them positively;
and it needs not to be either nervous or hysterical to be power-
fully influenced on the occasion of some anxious and doubtful
enterprise by the confident prediction that we shall succeed
or fail; the prediction, whether well-founded or not, aiding
materially in either case to bring about its own fulfilment.
We may know very well that the person has not adequate
grounds in a full knowledge of the circumstances to warrant
his prediction, but we are none the less affected by it, perhaps
against our better judgment, and cannot help suflfering our
energies to be either on the one hand distracted and weakened
or on the other hand concentrated and strengthened by it.
There are some persons whose habit of mind it is to balance
reasons so nicely that they find it very hard to come to a

II.] HYPNOTISM, SOMNAMBULISM, AND ALLIED STATE& 57

decision, and it is an extraordinary comfort to them when
another person will endorse or even only rehearse the reasons on
one side in a confident tone so as to give them a preponderant
activity ; they feel the relief and are resolved, notwithstanding
that the person who has helped them is not one whose judgment
they esteem much at heart, and notwithstanding that the con-
flicting reasons, when calmly weighed, are actually just as nearly
balanced as they were before.

It is well known how often a most absurd idea will hold
possession of the mind in dreams, and although it bears but a
very small proportion to the multitude of latent ideas in the
mind, with some of which it is absolutely incompatible, we are
entirely at its mercy for the time being, and have not the least
power to correct it. The wonder would of course be if we did
correct it when it is solely active, and if we did not believe
it when the rest of the mental functions^ being suspended in
sleep, are not susceptible to stimulation by it or by the custo-
mary impressions from without : in such case how can they
arise to correct or to contradict it, or to affect it in any way ? In
the hypnotic state the idea is isolated by a similar break of
functional continuity in the supreme centres ; the excitation of
the ideational track is such that, like a spasm or convulsion of
muscle, it escapes for a time from the controlling influence of
surrounding functions, and only, as it subsides, can be brought
again into co-ordination with them. We see the reason then of
the forgetfulness which is sometimes shown of what has taken
place in the mind during these abnormal trance-like states ; it
is the result and evidence of the extreme out-of-relationship of
the active idea, whatever it chanced to be, with other ideas,
wherefore there is nothing in the ordinary mental operations to
recall it. That it should be remembered, that is to say, should
recur, during these operations, would be exactly as if a particu-
lar convulsive movement should recur and take part in a series of
ordinary natural movements with which it is incompatible ; the
irruption of the abnormal movement would be the disruption
and inhibition of the normal movements. Should there be,
during a subsequent trance-like state, a remembrance of what
happened in a former one, as befalls sometimes, it is because

58 PATHOLOGY OF MIND. [chap.

the same state of things then recurs. Now instability of func-
tions is a character of the so-called nervous temperament ; there
is a tendency of ideas and movements to escape from the "bonds
of their functional relations, and to act independently — ^to break
away from coordinate and subordinate consensus of function,
and to become, so to speak, rfis-ordinate — ^not otherwise than as
an insane person is apt to disregard the obligations of the social
state and to break out into anti-social behaviour. It was for this
reason that I formerly described the temperament as the neurosis
spasviodica.

It might perhaps be set down as a general law that, given two
nerve-centres of mental function, they cannot be in equally con-
scious function at the same time ; if the one is actively conscious
the other will be sub-conscious, or not conscious at all ; and if
the one reaches a certain height of activity the efiTect upon the
other will be entirely inhibitory — it will be rendered temporarily
incapable of function.

In the hypnotic state the individual is on the whole less sen-
sible to external stimuli than in natural sleep, but more sensible
to the particular stimulus of the operator's voice than he is to
any stimulus in natural sleep, although, as I have before pointed
out, there are considerable variations in the degree of natural
sleep, and stories are told of some persons who have been almost
as susceptible to the suggestions of others as the hypnotic sub-
ject is. That he should be sensible to the operator's suggestions
with whom he is in sympathetic relation, and not sensible to the
suggestions of a bystander, agrees with the experience that a
person who is dreaming will sometimes hear and weave into his
dream, and perhaps even reply to, a question which happens to be
in relation with the idea of his dreams, or which is put to him by
a familiar voice. It agrees also with the fact that in the waking
state we habitually abstract consciousness from what we are not
thinking about, admitting only such impressions as are in rela-
tion with our reflections, and rejecting those which are not ; and
this we do not only voluntarily, but often without knowing what
we are doing, much more without specially willing it ; it is at
bottom an unconscious process, like that by which a strong
feeling arouses and fosters its sympathetic ideas, ignores and

iij HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES. 69

excludes unsympathetic ideas. We have only to exaggerate in
imagination this condition of normal reflection — to suppose it
to deepen through different depths of reverie, until it reaches
the morbid degree of hypnotism — and we shall have a partial
mental function with susceptibility to related impressions and a
complete inhibition of the rest of the mental functions.

When a person has been so unwise as to suffier himself to be
thrown many times into the hypnotic state he is very easily af-
fected ; the expectant idea will induce the state without anything
whatever being put before the eyes. Eeichenbach's experiments
on bis sensitive subjects whom he kept in his house proved, in a
ludicrous way sometimes, that there was hardly any circumstance
whatever, however trivial in itself, which might not occasion it
in persons who expected it and were accustomed to it. The habit
grew upon them, as we know that habits of nervous action, good
or bad, normal or abnormal, will do if they are encouraged. In
the first instance, however, a fixing of the attention through
vision seems to be helpful or even necessary, and if the object
gazed at be something so placed a little above the \e\e\ of the
eyes as to necessitate a greater strain of the ocular muscles it
will be more effectual By fixing consciousness in this way, in
other words, by keeping up a single act of undivided attention,
there is a subsidence of the general activities of the brain, which
thereupon goes to sleep. Were consciousness prevented from
wandering by being held in any other act of undivided attention,
whether it were by a mental image or by a muscular strain, the
result would no doubt be the same. The reason why the hyp-
notic subject is best aflfected through sight probably is that his
attention is easily arrested so, and that in no other way would
he be so capable of an undistracted act of voluntary attention for
any length of time : ask him to think of one thing steadfastly
for a few minutes, without ever allowing his attention to stray,
he would fail to do so; but when his attention is fixed in a
steadfast gaze upon some object to which it is solemnly directed,
with the expectation of something extraordinary being about to
happen, it is held involuntarily — distraction of consciousness is
prevented.

It is not a mere harmless amusement for one who is suscep-

60 PATHOLOGY OF MIND. [chap.

tible to the hypnotic trance to suffer himself to be frequently
practised upon, for there is danger of his mind being weakened
temporarily or permanently. Indeed were his will strong and
well-fashioned the operation could not succeed, for its success is
a surrender of the subject's will to the will of the operator, and
he is sometimes plainly conscious of a lessening resistance to the
latter's commands before he is completely subdued and yields
unconditionally. After coming out of the trance, a little time
must elapse before his will recovers its power ; for a while he
remains unduly susceptible to the suggestions of others, and too
easily influenced by commands. In the end, if the practice be
continued, he is likely to lose all control over his own mind and
to become insane ; the compact consensus of the supreme centres
has been broken up, a dis-ordinate tendency fostered, and the
dissociated centres are prone to continue their abnormal and
independent action. And assuredly that way madness lies.

I have only to remark further with regard to hypnotism that
it or a similar trance-like state is produced sometimes by
entirely physical causes. It has occurred now and then in con-
sequence of injury and of disease of the brain, without our being
able to trace the connection between the particular injury or
disease and the singular affection of consciousness. It is not
difficult, however, to conceive that a physical cause of irritation
in the brain may easily suffice for the induction of a state of non-
conduction, general or partial, in its delicate structural elements,
and that strange aberrations of consciousness will ensue in con-
sequence ; but of what really happens we know nothing definite
at present.

The condition which most resembles the hypnotic state is
natural somnambulism ; indeed the former might not unjustly
be described as an artificial somnambulism. We observe great
differences in the conditions of the senses in natural as in artifi-
cial somnambulism : the person may see without hearing, or hear
without seeing ; his eyes may be shut or wide open ; apparently
he may see some things and not see other things that are equally
within the field of vision ; the sensibility of one or more of the
senses may be considerably increased ; indeed, the gradations of
sense in different cases are such that the somnambulist may be

11.] HYPNOTISM, SOMNAMBULISM, AND ALLIED Sl'ATEa 61

on the one hand almost as clearly conscious of his surroundings
as when awake, or, on the other hand, almost as unconscious as
when fast asleep. Like the hypnotic, he sometimes remembers
during one attack the events of a former attack, although he has
no remembrance of them while he is in his normal state of con-
sciousness. At other times he forgets altogether everything
that happened during the attack: a fact which is in accordance
with the experience that the dreams in which a sleeper talks are
those which are least remembered. In a few instances he remem-
bers something of his dream, imperfectly and confusedly, espe-
cially when a scene or incident in the day chances to recall it.

Because the somnambulist plainly does not see things near

him sometimes, though his eyes are open, and nevertheless shows

by his behaviour that he does perceive other things that are

not so close to him, it has been supposed that he has the power

to perceive through some other channel than the ordinary senses.

If he manifestly does not see one thing which is right before his

eyes, how can he see another, it may be reasonably asked ? The

answer is that he sees what is in relation with the ideas of his

dream : the avenue of sense is open to the apprehension of an

object the idea of which is active in his mind, and shut to those

objects which are not in relation with the images of his dream.

In like manner he may not hear some sounds, though they are

pretty loud and startling, and yet may hear other sounds which

are woven into the fabric of his dream and perhaps give a new

direction to it. The occlusion of sense to what is not necessary

to the immediate business is the main reason probably why he

is able to walk cleverly and fearlessly over roofs of houses and

other dangerous places where he would not like to venture if

he was broad awake. Seeing only what he requires to see for

his purpose, he is not distracted by seeing other things which

miglil dissipate his attention, and his undivided energies are

given unreservedly to the accomplishment of what he has to do.

The way to do a difficult thing which is feasible is not to see

vaguely the difficulties, but to see definitely the means of success ;

the energies are then undistracted by any halting considerations.

The hypnotic, whom we may consider to be in a single state of

consciousness, has been known sometimes to ^i5.e.c\)L\^ i^^\s. ^\.

G2 PATHOLOGY OP MIND. [chap.

muscular strength or agility which he would have found it
hard or impossible to do in his nonnal state. Another reason
of the fearless feats of the somnambulist — fearless, but not so
safe for him always as is popularly supposed — ^is perhaps the
heightened sensibility of his muscular sense, by virtue of which,
like a blind man, he is susceptible to finer impressions, and
receives more precise and certain information to guide his move-
ments. There is reason to believe that the sensibility of the
other senses may be increased sometimes, as is undoubtedly the
case in artificial somnambulism ; through a keener sensibility of
the retina he may get an advantage of discriminating objects in
the dark equal to that possessed natui-ally by such nocturnal
creatures as owls and cats ; and the increase of auditory or tactile
sensibility, by enabling him to apprehend such slight impressions
as he could not discriminate in his normal state, might well
give a miraculous semblance to his perceptions. Of one of his
so-called " sensitives " Eeichenbach relates that " all common
light was a burthen to her, pained her, and dimmed the clearness
of her perception. Her sight was good in proportion to the
depth of darkness about her." But we have more sober and
trustworthy authority, were it needed, in the testimony of
Cabanis and others who have witnessed quickened sensibility
of each sense in different cases of artificial somnambulism.

Notwithstanding the high authority of Sir W. Hamilton, who
declared that, however astonishing, it was " now proved beyond
all rational doubt that in certain abnormal states of the neiv^ous
system perceptions are possible through other than the ordinary
channels of sense," it would not be profitable to discuss at
length the question whether somnambulists, natural or artificial,
ever perceive otherwise than by their natural senses — whether,
for example, they ever read, as is sometimes affirmed, through
the pit of the stomach or through the back of the head.^ With-
out doubt they sometimes imagine they do: having perhaps,
as hysterical women often have, anomalous sensations about the

^ "It is quite indifferent,*' eays Reichenbach, "to the high-sensitives
whether their eyes are bandaged and glued over or not ; it is for them
about the same as it would be to bandage the elbow of a non-sensitive
who has good eyes to keep him from seeing a camel."

¥

HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES. 88 ■

epigastrium or in other parts of the body, they misinterpret
their character, and attribute to them perceptions which have
been got actually in the ordinary way through the natural
channels. But it invariably happens, when the extraordinary
powers which they imagine or affirm themselves to have, and
which credulous folk believe them to display, are rigidly tested
by competent inquirers, that the miracle explodes. They will
claim a power of looking into the bodies of other persona or
into their own bodies, and will describe with measured utterance,
as if their speech followed the gradual disclosures of the eye.
the conditions of the internal organs and the nature and position
of any disease which may be going on, raising much wonder
and entii'e belief in the minds of persons who are ignorant of
anatomy, or who have only a dim book- know] edge of it ; hut
when their statements are tested by a competent physician they
will be found to be vague and absurd, such as might have been
easily founded on the remembrance of some anatomical drawing,
and it will commonly be possible, by affecting an air of entire
belief, aud betraying not the least sign of suspicion of their
powers, to lead them to the description of all sorts of im-
possible diseases in impossible places. They follow the sii^es-
tions made to them in the leading questions that are put, and
express the vulgar notions of diseases and their treatment, just
as the spirit of a great philosopher or a great poet, when it re-
visits earth to assist at a apiritnalistic siancc, utters the vulgar
sentiments and thoughts of the medium who has summoned it.
The predictions of future events which some of these somnam-
bulistic performers rise by degrees to the audacity of making
are equally fanciful ; when soberly tested, the prophetic insight,
like their medical insight, proves to be delusive. They usually
grow to the height of their presumption step by step as they
succeed in imposing upon the amazed believers in their preten-
sions, whose credulity to the end keeps pace with their audacity :
Eeichenbach was convinced that no secret act done in liis house
escaped "the all-piercing eye of the acute sensitive," and after
saying that they are sometimes of sei-vice in the medical art,
by discovering the nature of disease and foretelling its future
^urse, and by telling such things aa whethtt fhtxe \a a. ■^tqw;.?.'*'

I

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PATHOLOGY OF MIND. [cffil

ttat a woman will become a mother and whiit the sex of her

offspring will be, he naively tells a story to show how dangerous
or useful this faculty may be : — " In my own liouse it happened
that a somnambulist whom I introduced there denounced a
servant girl for immoral conduct, in which nobody believed, and
the truth of her declaration was only established after months ;
and other revelations which she made caused a revolution in the
house and resulted in the dismissal of several servants."

It will not be amiss to eonnider briefly what are the causes
that have given rise to the belief in the prophetic and other
singular powers of these somnambulists.

a. First of all, then, there are the genuine impostors, who out
of an itching desire of notoriety or for purposes of gain made a
profitable trade of the business of deceit. From the earliest times
of which we have record unto the present time there have not
been wanting knaves to practise upon the credulity of fools, and
they have perforce found the choicest fields for their enterprise in
those dark places of nature where mystery begets wonder, and
wonder in turn begets credulity. Where the forces and tlie laws
of nature are not known, there has always been a class of
persons claiming supernatural relations and pretending perhaps
to supernatural powers, who have made their advantage out of
the ignorance and fears of their fellows ; and so it no doubt will
be until it comes to pass, if it ever shall come to pass, that all her
secrets are won from nature, and no dark place is left in which
superstition can lurk.

h. Secondly, there are the impostors who impose upon them-
selves as well as upon others ; whose self-deception is in tnith
the main factor of their success in imposing upon others. It
has never been sufficiently taken into account, I think, that
deception is not a constant tut a variable quantity, and that
there are manifold gradations between the most deliberate and
wilful deceit on the one band and on the other hand a deception
which is unconscious and innocent One of the arguments
upon which believers in the mi ac ! u p eeptions of the
hypnotic lay the greatest stress i tl t tb ) a exhibited and
attested sometimes by persona \ 1 m th y kn w to be utterly
incapalile of fraud and on who n ty nl veracity they

HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES. 6fi§

■would hazard all tbat they possess. Agreeing with tliem aa to-i
the sincerity, one may still properly call in question the com-
petence, of the witness, who may speak the trath as he kaow4.j
it, without thinking the truth as it la ; for the question is notj
merely whether he is deceiving us, but whether he is himself)
deceivecL His consciousness, no douht, testifies truly
own states ; but it may not testify truly as to the causes of
them. It is not amiss to reflect when weighing beliefs that belief
is very much a matter of temperament, and that there are persons
of a certain temperament who are prone to beheve anything that
baa passed vividly through their imaginations without con-
sidering sufficiently how it came there ; solemn asseveration of
a fact by them meaning no more than a conviction of a vivid
mental experience. The temperaments of such persons ara
unstable in this respect — that the members of tliat congeries of
supreme nerve-centres which constitute the cerebral convolutions
are not bound together in compact communion, of function, but
are apt easily to take on in-coordinate action, not perhaps of an
actually incoherent kind, although that is a further stage of
degenemtion, but of too isolated and independent a character.
Thus it comes to pass that when a vivid conviction takes hold
of the mind it vibmtes there intensely, and does not feel the
controlling and modifying influences, consciously or uncon-
sciously working, of the neighbouring mental elements with
which it is in physiological union ; nay, it may even inliibit tem-
porarily their functions altogether. It becomes tlien an intense
belief which is never properly tested and corrected by sound
observation and sober reflection. To say that the great majority
of men reason in the true sense of the word is the greatest non-
sense in the world ; they get their beliefs, as they do their instincts
and their habits, as a part of their inherited constitution, of
their education, and of the routine of their lives.

It is evident that this sort of temperament lends itself easily
to self-deception. If an idea reach that persistent and exclusive
action which entails an inhibition of the functions of the other
ideational centres, as it notably does in the hj'jmotic and its allied
states, it is plain that when the person comes out of the exclusive
slate of consciousness he or slie may be oblvvioos ol -«W\-

I

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66 PATHOLOGY OF MIND. [cdap.

thought or done when in it, and so may, with perfect sincerity,
deny his or her deeds and misdeeds, or assert them to have been
inspired and directed by some power more than natural.
Alienated for the time being from his full self, he feels the
alienated self to have been a strange or another self, and cannot
realise responsibility for its doings, even if he remembers them.
Between the abnormal state of consciousness which belongs to
the hypnotic state and the state of consciousness which accom-
panies the most deliberate deception there are transitional
grades, whence the manifold gradations that are actually met
with between wilful deception and innocent self-deception, and
the reason why persons whose sincerity their friends recoil from
suspecting do nevertheless dupe themselves and others of sym-
pathetic temperament in the grossest manner. Just as the string
of a harp vibrates to and gives back the note that is in unison
with it, so the dupe vibrates to and gives back the note which
the impostor strikes.

c. It is certain that a large, though not certain how large, a
margin for error should be allowed to defective observation in
these matters. True observation comes not by instinct, but is
gained painfully by training. Were a list made of the common
fallacies to which observation is liable, and to each one assigned
its proper share in these wonderful phenomena, there would be
little left unallotted to dispute about. It is a well-known
tendency of the human mind, which has been the foundation of
the credit of prophets in all ages, to be impressed strongly by
agreeing instances, and to overlook or neglect disagreeing or
opposing instances. When the mesmeric subject makes a hit
the effect is startling and the admiration unbounded, while his
manifold failures are ignored and forgotten, or attributed to
the unfavourable conditions of the experiment. Moreover, the
observation of a particular experiment is commonly partial and
defective, the observer seeing an effect which strikes his atten-
tion and overlooking the essential conditions on which it
depended : he may, as he earnestly asserts, have seen the thing
with his own eyes, but what we require to have noticed are the
various cooperating conditions or coefficients which he did not
see and take notice of, and which a cooler, more wary and skilful

II.] HYPNOTISM, SOJMNAMBULISM, AND ALLIED STATES. 67

observer would have seen, noted, and weighed. It is beyond ques-
tion, as Voltaire truly remarks, that magic words and ceremonies
are quite capable of most effectually destroying a whole flock of
sheep, if the words be accompanied by a sufficient quantity of
arsenic. The proper answer to the person who has seen miracles
is certainly in nine cases out of ten a direct declaration that not
the least reliance can be placed upon his observing powers, and
a blank refusal to discuss his observations ; for life is too short
to permit the waste of time which would be required in order
to teach the alphabet of observation and reasoning to each
new-comer.

Obviously persons of the neurotic temperament described will
be most liable to this sort of defective observation. Possessed
vividly with an idea, the faculties of their minds are benumbed
or suspended : they can see only what is in relation with the
predominant idea. It is notorious that the observer who starts
with a preconceived idea or with a strong desire is so far dis-
qualified rather than qualified for his work; for although his
special observation may be sharpened by the idea or the desire
to see what is agreeable to it, his general powers are blunted, and
he is very likely to be deluded ; but these neurotics are particu-
larly liable to be dupes of a partial observation, because of that
easily induced solution of continuity of functions by which an
idea, when unusually active, escapes from the restraints and
corrections of the communion of nerve-centres of which its
centre is a member. These considerations teach how gradational
is the transition from the simplest instances of defective obser-
vation, such as are continually exhibited by all men, to the
extreme instances of entire incapacity of observation which the
mesmeric or somnambulistic subject displays. Not to suffer
any present mental state to reach an inordinate activity, but to
maintain a free play of all the various chords of association
which a wise culture has made as many and complete as pos-
sible, and so to preserve the sound balance of the judgment,
is the mark of a large and well-trained intellect.

d. It may be alleged that, after making full allowance for de-
ception and for errors of observation, there is still an unexplained
residuum of the wonderful in the foresight displayed by some

^H aa

" V.

PATHOLOGY OF MIND. [oh

L

of these mesmeric subjects. TLcy have predicted clearly, it is
aaid, a disease from which they themselves would suffer, and
eventually did suffer, although there was not the least sign of the
at the time when they foretold it. If thia were true, and
the coincidence were not accidental, it may he supposed, before
acknowledging a supernatural event, that a heightened sensibility
had rendered them more susceptible to the earliest indications
of disease — ite mute premonitions, so to speak — than they were
in their normal state of consciousness, just as a person will feel
a sensation when his attention is free vrhich passes unnoticed
when be is actively employed. Or, if that explanation is not
accepted, it may be supposed that the disease occurred as the
result of a fixed idea in a sensitive mind tliat it would occur, the
prophecy having fulfilled itself, not otherwise than as the idea
of gaping, of pain, of paralysis, of convulsions, will sometimes
induce gaping, pain, paralysis, convulsions. It cannot be too
clearly apprehended that there is a sort of innate tendency to
mimicry in the nervous system : one observes the most striking
manifestations of it in apea and in children, and less striking
instances of it in the way in which a person oftentimes adopts
unconsciously some of the tricks of manner or of expression of
another with whom he associates ; and certainly the simiilation
or mimicry of disease by so-called nervous or hysterical persons
ia common. As in such persons the idea of a particular disease,
if it takes hold of them, will be likely to reach that prepon-
derating and persistent activity when it cannot be moderated by
reflection, which it inhibits, it may be expected to act with excep-
tional power upon the organic functions, if its encT^y takes that
channel, just as the exclusive idea of the hypnotic subject when
it has a motor outlet nerves him to a feat of muscular strength
or skill of which he is incapable in his normal state.

e. When the artificial somnambulist succeeds in reading what
is in the mind of another person who utters not a word of what
he is thinking, as is sometimes the case, his success is due in
the main to an acute apprehension of slight outward indications
of his thought, which the person may be entirely unconscious
that he is exhibiting ; the proof of this being that the experi-
jaenfc fails when it is tried with one who, being increduloos,

^Hq hypnotism, somnambulism, and allied STATEa 69 .^H

4

cai'efuUy suppresses the least expression of what h in his
mintl, or of set piupose puts on a different expression of features.
There are very few persons who are skilful enough to prevent
their thoughts and feelings affecting their movements. Let it
be considered how quickly children and animals read our moods
of mind in our faces, and what acute perceptions of the raotiona
of a speaker's lips a deaf and dumb person is trained to attain,
so that he can understand the mute motions as well almost as if
he heard the words spoken, and it will appear probable that a
vivid thought may manifest itself unconsciously in slight move-
ments of lips or features which, unperceived by an ordinary
observer, do not escape the acute apprehension of the so-called
sensitive. Tliis is without doubt the explanation of the so-
called muscle-reading which has lately attracted notice. I am
not sure, however, that the knowledfje is not obtained in soma.
of these cases without the conscious agency of the subject — ta
wit, by an unconscious imitation of the attitude and expression
of the person, whose exact muscular contractions are instinct^
ively copied ; the result being that, by virtue of a well-kniown
law, the same ideas and feelings of which the muscular contrac-
tions are the proper langut^e, are aroused in the subject's mind.

Another explanation, but a fancifiJ one, may possibly be true
of occasional instances of success. They may be owing to the
sympathy of similar constitutions iinder tlie same external con-
ditions whereby tbeir thoughts and feelings chime, the two
natures striking the same notes independently, like two clocks
striking the same hour at the same time. Kefore rejecting the
hypothesis, let it be fairly considered that there are a great many
persons who are pretty nearly automatic repetitious of one
another so far as regards the range and character of their
thoughts; they think the same thoughts just as all parrots and
children constantly make the same noises and go through the
same performances without imitating one another ; and when they
are under the same external conditions, when their feelings are
attuned to the same note, when their minds are acted upon by
the same suggestions, as is the case where both are engaged in
one experiment, it is not perhaps to be wondered at that there
should be an independent chiming of tboa^lils Kui. i^i^'a'^i

I

i

70 PATHOLOGY OF MIND. [chap.

occasionally. Two such persons would probably make the same
movements in order to escape if they were exposed together
suddenly to a common pressing danger^ without consulting with
one another ; and I doubt not that a young man and maiden,
when they fall in love with one another, naturally think the
thoughts, feel the sensations and emotions, and do the things
which young men and maidens have always thought and felt and
done in similar circumstances, without having to learn their
lesson either from one another or from any one else. The
Siamese twins who, being bodily bound together, perforce lived
under the same conditions, were united in a close mental
sympathy for a great part of their liveis ; they generally had the
same thoughts at the same moments, made the same resolves and
did the same things without previous communication with one
another ; unfortunately the happy harmony did not last, for one
of them became addicted to intemperance, a vice which led to
frequent bickerings and disputes, and in the end to an earnest
desire to be separated. The close sympathy of feeling and
thought sometimes shown by ordinary twins is well known, and
there are one or two remarkable instances on record of twins who
were attacked with the same form of insanity at the same time,
while several cases have been recorded of brothers or of sisters
who, having lived much together in the same external conditions,
have become similarly deranged.

Another of the intermediate states which bridge the gap
between the most abnormal and the normal states of conscious-
ness, and closely allied to the abnormal states already described,
is ecstasy or trance. This ecstasy is a condition into which the
enthusiast of every religion, Buddhist, Brahmin, Christian,
Mahometan, has contrived to throw himself, and is truly, as
the word means literally, a standing out of himself. The
symptoms are very much alike in all cases : after sustained
concentration of the attention on the desire to attain to
an intimate communion with heavenly things, the self-absorp-
tion being aided perhaps by fixing the gaze intently upon
some holy figure or upon the aspirant's own navel, the soul
is supposed to be detached from the objects of earth, and
to enter into direct converse with heaven ; the limbs are then

II.] HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES. 71

motionless, flaccid, or fixed in the maintenance of some attitude
which has been assumed, general sensibility is blunted or
extinguished, the special senses are insusceptible to the impres-
sions which usually aflfect them, the breathing is slow and feeble,
the pulse is scarcely perceptible, the eyes are perhaps bright and
animated, and the countenance may wear such a look of rapture,
the fashion of it be so changed, that it seems to be transfigured
and to shine with a celestial radiance.

Ecstasies of this kind are much less common nowadays
than they were in past ages, when religious feeling and belief
had a more vital hold of human thought and conduct : when
numerous monasteries were scattered over the land ; when
austerities and asceticism were in vogue ; when prayers,
penances, meditations, and religious ceremonies filled up the
main business of life; when a disunion from the things of
earth and the closest union with the things of heaven was
set forth as the end to be perpetually aimed at in order to
escape everlasting torment. However, as Maury has pointed
out, these trances in which supernatural communications took
place did not befall saints only, for the wicked were sometimes
seized by them, and gave blasphemous recitals of their visions.
Hence it became necessary to make two classes of ecstatics —
the holy and the demoniacal, or, as I might fitly call them,
theoleptics and diaboleptics. It would be rash to venture to
say to which class are to be referred the ecstatics who from time
to time are heard of at the present day, famous among whom
is Louise Lateau, known as the Belgian stigmatic, because
during her often-recurring trances marks of bleeding from the
forehead, from the left side, and from the palms of the hands,
are seen.

Obviously the ecstatic state is very much like the hypnotic
state both in its mode of occurrence and in the character of its
phenomena. There is such a vivid exaltation of a particular state
of consciousness that sensibility is suspended, voluntary move-
ment inhibited, and vital function itself lowered. St. Theresa
described her state of rapture as one in which " the body loses all
the use of its voluntary functions and every part remains in the
same posture without feeling, hearing, or seeing, ^\»\e,'ec8»\i ^q \ys» \»^

72 PATHOLOGY OF MIND. [chap.

perceive it." When she had a mind to resist these raptures " there
seemed to be somewhat of a mighty force under my feet which
raised me up that I knew not what to compare it to " ; in other
words, when the energies of the unstable nerve-centres were not
suffered to discharge themselves in the tension of a particular
strain of consciousness they troubled the centres of muscular
sensibility, and produced the motor hallucination of an eleva-
tion from the ground, just as they might on another occasion
have produced vertigo. There is not in all cases an entire
insensibility to external impressions ; like hypnotics, these
ecstatics are sometimes sensible to impressions that are in
relation with the ideas of their visions, and then mix the real
with the imaginary ; they may gaze, for example, on a crucifix
on which a Christ is suspended until they hear him speak or
see him descend and approach them, and they will show them-
selves conscious sometimes of the presence and of the words of
one whose sacred character or function suits the strain of their
rapture. But the insensibility to pain sometimes is very re-
markable. Eapt in his gay vision of unreal bliss, the religious
fanatic of India is indifferent to the wounds and injuries that
are inflicted upon him and will, without wincing in the least,
suffer his body to be tortured in a way that must, were he in a
normal state of consciousness, produce intolerable pain. The
natives of India and all primitive races are more susceptible to
these trance-like states than are Europeans, as was shown by
numerous experiments to perform surgical operations on persons
put into the mesmeric state ; for while it was easy to throw the
natives into the proper state of insensibility for the operation,
the experiment was usually unsuccessful with the European
soldier. Among the North American Indians it was the custom
to tie the prisoner of war to a stake before he was executed and
to subject him for several hours to all the means of torture which
savage ingenuity and ferocity could devise, women and children
joining with eager delight and acclamation in the cruelties
practised upon the victim. He, meanwhile, scornful of their
impotent efforts and disdaining to show the least sign of pain,
defied his tormenters with the bitterest irony and the most in-
sn)ting sarcasm, boasting exultantly how many of their kindred

11.] HYPNOTISM, SOMNAMBULISM, AND ALLIED STATE& 73

he had slain, how horribly he had tortured them, and jeering
them contemptuously for their futile attempts to make him
sufifer. His transport of mental exaltation made futile their
hellish efforts. I doubt not that the Christian martyr, in a like
condition of mental exaltation, has sometimes borne the flaJtnes
of the stake, when burned to death, or the other tortures under
which he has expired, with an indifference and a composure that
seemed to onlookers the proof of a supernatural support. When
one thinks of the fearful record of man's inhumanity to man
which human history is, it seems a happy thing that there has
been mercy enough in the dispensation to put bounds to the
power of human malignity to inflict torture, whereby achieve-
ment has fallen so far short of desire — first, in the limit which
there is to man's capacity to sufifer, whereby pain itself kills,
and, secondly, in the power of enthusiasm to defy torture.
The dancing manias of the middle ages, the so-called con-
vulsionists of St. MMard, and similar mental epidemics in
which an infection of enthusiasm spread through persons placed
in the same conditions, have furnished many instances of
general insensibility to violent blows and to other severe
handlings while the mind was rapt in the ecstasy of the
particular excitement. The only remark which it remains to
make concerning these ecstatics is that while they oftentimes
remember what has happened during their visions and angelic
communions they sometimes, like somnambulists, have only
a confused remembrance or no remembrance at all; their
experience cannot be recalled and described, for, as they imagine
and declare, it was of such a character as to transcend ordinary
thought and expression, truly ineffable.

A disease which' is closely allied to the abnormal states de-
scribed, holding an intermediate place between them and epilepsy,
is catalepsy. The person who is subject to cataleptic attacks
falls suddenly into a state of seeming unconsciousness, but does
not fall down ; he maintains the attitude in which he was at
the time when he was seized, just as if he had been thrown
suddenly into the brownest of " brown studies," continuing to
stand if he was standing, to sit if he was sitting, to kneel if he
was kneeling. The act he was doing is sus^^xiAaA. \£!cv&?«^ \s^

74 PATHOLOGY OF MIND. [chap.

its execution. To all appearance he is little more than a half-
animated statue while the paroxysm lasts. He seems partially
or completely insensible to external impressions, and when his
arm or any other part of the body is put into a certain position
that position is retained for an indefinite time, or until he comes
to himself again. The pulse is usually more feeble and the
respiration more slow than in the natural state. The fit may
last for a few minutes only, or for a few hours, occasionally for
a yet longer period, and when it is over there is no memory of
what has happened during it No particular mental state,
voluntary or involuntary, seems to have anything to do with the
induction of the cataleptic state, although it is probable enough
that a moral shock might be the occasion of an attack in one
who was subject to the disease ; it has occurred where there was no
reason to suspect actual disease of the brain, and it has occurred
where there was grave organic disease thereof ; but concerning
the actual conditions of its occurrence we know nothing.

I go on now to direct particular attention to the strange
abnormal states of consciousness that are sometimes witnessed
in persons who suffer from epilepsy. It is well known that one
who is a victim of that form of epilepsy which is called le petit
Trial will sometimes, during the temporary suspension of con-
sciousness, continue without interruption the mechanical work
which he was doing at the moment when he was seized — will go
on walking if he was walking, sewing if he is a tailor who was
occupied in sewing, playing on the violin if he is a musician who
was so employed. It has furthermore been observed that the
suspension of ordinary consciousness may be more than mo-
mentary in certain so-called masked epileptic states, and that
during its suspension the person, to onlookers appearing as if he
were conscious of what he was doing, may go through a train
of new and more or less coherent acts which when he comes to •
his natural self he is unconscious of having done. Like the
somnambulist, he has been in an abnormal state of conscious-
ness, during which he acted as if he were another being, knowing
not what he did, or, if he did know it at the time, not re-
membering it afterwards. But it is most probable that he did
not know it; for what he does, although it may have method in

iL] HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES. 75

it, is commonly inappropriate and foolish, and nowise called for
by the external conditions of his surroundings, of which he
seems unconscious.

On one occasion I was consulted by a gentleman, aged
twenty-three, of good muscular development, brisk intelligence,
and unusual energy of character, who had for some time
worked very hard at a business which involved considerable
strain and excitement. For five years he had suffered from
epileptic or quasi-epileptic attacks ; at first he had fallen down
in them in the ordinary way, but after a time they came
on with a feeling of trembling and of loss of power in the
knees, immediately upon which the unconscious state supervened,
but he did not fall down ; on the contrary, while this abnormal
state lasted, which it did for an hour usually, and sometimes for
hours, he did strange acts, not knowing what he was doing, or if
he was in the street went along in such a dazed and uncertain
way that the police, thinking him drunk, interfered with him.
A few days before his visit to me he had had an attack in the
street, and he remembered nothing whatever of what occurred
from the beginning of it until he found himself in his oflSce
to which a friend who had seen him, and recognised his
plight, had conducted him. From another friend who resided
with him I learned that when he was in the attacks he seemed
to be partly aware that he was not well, told them what should
be done to him, and spoke of whatever might be in his mind,
not always quite coherently, but usually tolerably so. On two
occasions he had been restive, as if he wished to get away ; once
he had behaved as if he were going to be drowned, and at another
time he had acted as if he were going to get up the chimney.
Before or after the attacks he suffered from bad* headaches,
which were formerly so severe as to compel him to lie down
wherever he chanced to be until they passed off, but the pain
had not been so severe lately. The immediate occasion of his
visit to me was a great nervousness which had come upon him ;
he was apprehensive of going about alone or of sleeping alone,
and was much distressed by absurd impulses which tormented
him and which he could hardly control, although he knew very
well how absurd they were, and tried hard to laM^\\\\xi%^i <svi^

I^fi PATHOLOGY OF MIND. {out

^^B of them, or late the impulse to get up the chimney had

^^K tormented him fur no reason whatever, and it hod gron'n so

^^B strong that sometimes he had the greatest uientnl struggle to

^H prevent himself from yielding to it. Other niovbiil impulses

^^B had afflicted him: at one time he had felt impelled to drown

^^p himself in the washhand basin, and at another time to throw

himself in front of a railway train when he saw one ajiproach-

iiig ; when one impulse left him another took its place. From

time to time a black curtain or clond seems to fall before his

Peyes, is accompanied by a peculiar sensation or pain in the head,
and for the moment he is scarcely conscious ; hut the attack,
which is doubtless of an epileptic nature, quickly passes off.
The morbid impulses which reason inhibits with difficulty no
doubt mark a condition of nerve-centres of the snme kind as,
but less morbid in degree than, that which exists when reason

I and will are entirely suspended and the persistence of conscious-
nes.'j even is doubtful
I forbear to quote other simUar cases in which odd, stupid,
and even dangerous acts have been done during the epileptic
suspension of normal consciousness, or to attempt a speculative
explanation of them. To call the person's conduct during the
paroxysms automatic does not help us much to understand it ;
it is so like much of his conduct when he is not in a paroxysm
that one is inclined to ask whether that is not automatic alsa
Plainly hia state is roost like an acted dream, and bears out the
sagacious opinion of old medical writers that there is a kinship
between somnambulism and epilepsy ; a kinship which reaches
not merely to a resemblance of phenomena, but has a deeper
basis in a conmion neurotic temperament. In trulh all these
lepsies or peculiar nerve -seizures — epilepsy, catalepsy, theolepsy,
^^ and somnambulism, betray in most cases a neurotic inheritance,
^^h and may justly be suspected to be very likely to leave a neurotic
^^K legacy. By bringing them together, as I have done in this
^™ chapter, it has been shown that the most extreme and abnormal
instances of double consciousness are not so widely separated
from states of normal consciousness as they appear to be at first

1 sight, and that we may, if we will, pass from one extreme to
the other over a bridge of many arches. It is certainly impos-

w^^^

II.] HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES. 77

sible to realise the state of mind of a person who is in one of
these states of abnormal consciousness; conscious one's self or
unconscious, one cannot form accurate conceptions of the inter-
mediate anomalous states ; but the experience of a person who,
when taking chloroform in order to be rendered insensible,
struggles, kicks, shouts in a sort of nightmare after he has
ceased to see or hear, but before he is completely passive and
insensible to external constraint, feeling it but not in the least
realising its true nature, may convey an imperfect idea of the
quasi-unconscious state of the epileptic who does strange things
that he wots not of. The main features which the abnormal-
states present in common are: first, that coincident with a
partial mental activity there is more or less inhibition, which
may be complete, of all other mental function ; secondly, that
the individual in such condition of limited mental activity is
susceptible only to impressions which are in relation with its
character and are consequently assimilated by it ; and, thirdly,
that when he comes out of his abnormal state he may have only
the most dim and hazy remembrance of what happened when
he was in it, or may not remember it in the least.

If any one will be at the pains to examine the phenomena
of the modem epidemic of superstition which is known as
spiritualism by the light of the foregoing exposition, he will be
able to weigh at its true value much of what seems to be the in-
contestable evidence of eye-witnesses who vouch for miraculous
phenomena. A great proportion of them are undoubtedly the
work of impostors consciously duping their victims, who, pre-
disposed by temperament and a want of training in observation
to believe the wonderful, are an easy prey. If the performer is
skilful by reason of natural aptitude and long practice, he
may easil}^ like a conjuror, frustrate the attempts of even
a good observer to detect his mode of operation. We are
unable to discover how the conjuror does his tricks, although
we know them to be tricks, partly because he is clever enough
to distract attention in some way from what he is doing at
the critical moment of the feat, and partly also probably
because a muscular act may be quicker than perception — so
quick, in fact, as to be imperceptible, as the t\\i\\VV\n« ol «a ^^v?^

78 PATHOLOGY OF MIND. [chap.

which is a muscular act, commoiily is. Then there are the
unconscious impostors who, like the hypnotics, get their minds
into a sort of convulsive activity of certain ideas with a
temporary paralysis of all other ideas, and are unconscious
themselves of the fraud which they are practising, or at any rate,
like one in a dream, morally insensible to the guilt of it.

The extraordinary revelations of names, of events, and the
like, which the ''medium" makes sometimes under spirit-
guidance, and which it is supposed could not possibly have been
known in any natural way, are of the same nature as the similar
wonders of the mesmeric trance. A heightened sensibility of a
particular sense, giving information which it could not have
given in its ordinary state, will account for some extraordinary
perceptions ; a revival in memory of forgotten facts which the
individual himself may not remember that he had ever known,
such as notably occurs sometimes in dreams, will furnish the key
sometimes to knowledge which looks marvellous to onlookers ;
an increased muscular power owing to the concentration of the
whole nervous energy upon an act, and to the full faith that he
can do it, may enable the medium to perform a feat of strength
or of skill which he would not find it easy to do in his natural
state, when some distraction would prevent the fulness and mar
the unity of the effect. Of course if it be true, as the spiritual-
ists allege, that a table will rise from the floor and float about
the room when the medium neither touches it nor has any sort
of physical connection with it, another explanation must be
sought for. One may venture to conclude in accordance with
experience of known phenomena that the person who sees a
table float through the air, or feels it rise from the groimd when
his hands are placed upon it, is labouring under a motor hallu-
cination of eye or of touch, a sort of hallucination which it is
easier to have than most persons think. Possessed with the
expectant idea that a movement will take place, he has the
vivid motor intuition or mental presentation of that movement
stirred into activity, and the motor intuition, which has been
thus excited subjectively, is projected objectively and takes
sensible form as an actual movement, not otherwise than as
a ^iddy person sees the room turn round : it is the objective

If.] HYPNOTISM, SOMNAMBULISM, AND ALLIED STATES. 79

aspect of his subjective state. If he conceive the idea of a
rising or of a floating table so vividly that it excites the corre-
sponding motor intuition to the pitch of hallucination, it is
impossible he should not actually feel or see the movement ; no
wonder therefore he asserts solemnly that he saw it with his
own eyes. As I have pointed out already, many saints are
alleged on the testimony of eye-witnesses to have floated in the
air, among whom may be mentioned St. Philip N(5ri, St. Dunstan,
St. Christina, and lastly St. Seraphina, a nun in whom the
tendency to rise was so great that six nuns could not hold
her down. These flights took place during the raptures or
ecstasies into which these holy persons fell ; and it will hardly
be doubted by those who class the phenomena scientifically
with the rides of witches through the air that some of the
saints had the cotiviction, which persons in dreams have some-
times, that they did actually float in the air during their
ecstasies. What then with the motor hallucinations of the
saints themselves, and what with the motor hallucinations of
the admiring observers who, being not of little faith, did not
doubt, there is quite enough to account for the stories of the
flights, without appealing to supernatural aid.

It has been proved amply by experiment, as it might
have been predicted safely would be the case, that faith is
necessary to the manifestation of the phenomena of spiritualism;
the presence of a sceptic renders the conditions unpropitious,
and nothing extraordinary takes place. That has been so with
miracles of all sorts from the beginning of the world unto the
present day; they have chanced to occur in the presence of
believers who were so full of faith that they needed not to have
their faith strengthened, and they have not chanced to occur
in the presence of unbelievers, whose doubts might have been
dispelled by their most potent evidence. The spiritualists
refuse to submit their marvels to the rigorous and critical
examination of sceptics who are competent to test them ; they
insist upon making conditions which render satisfactory inquiiy
impossible ; and when the sceptics refuse to be handicapped by
such conditions, and insist upon the same perfect freedom of
doubt and of experiment which they would use m ^xoj \,\>c\'^

80 PATHOLOGY OF MIND. [chap.

scientific iuquiry, they forthwith charge them with prejudice
and a refusal to investigate. They appeal too to the testimony
of their own witnesses, who, being ardent believers, are quite
incapable, notwithstanding the best intentions, of observing
correctly and of detecting fraud which is not glaring ; for they
are like the hypnotic or the somnambulist, who sees only that
which is in relation with his ideas and will assimilate with
them. Faith in things unseen and spiritual that are believed
to act upon things seen and material is incompatible with tme
observation of things seen, for observation is vitiated funda-
mentally, and cannot be unbiassed and adequate.

In concluding the chapter one thing may be noted with
regard to spiritualists : that many of them, especially the most
eager and intense among them, have the neurotic temperament,
which goes along with epilepsy or insanity or other allied
nervous disease in the family.^ I need not repeat what I said
before concerning the outcome of this temperament in belief :
the lame, the halt, the blind, the warped in intellect, who follow
eagerly dark by-paths of belief, may be gathered together into
one fold : their aberrant and fanatic beliefs, over which reason
has no sway, betray the character of their temperaments. To
strive by argument to modify their convictions is a vain
imagination and a futile labour : it is to labour to argue away
a temperament ; and that is work which a wise man does not
undertake.

^* You may as well
Forbid the sea for to obey the moon
As or by oath remove or counsel shake
The fabric of his folly, whose foundation is
Piled upon his faith, and will continue
The standing of his body."

^ The London Dialectical Society appointed a committee to investigate
the subject of spiritualism. The committee took the evidence of a great
many spiritualists and published a report. However, **of the compara-
tively small number of persons who were conspicuous either as advocates
or * mediums,* one became the subject of well-marked mental illness, and
another had to be confined in a lunatic asylum. A third person, who was
an eager member of one of the sub-committees, was seized with a
mysterious form of paralysis, although comparatively a young man." —
Rep<yi't on Spiritualism, p. 80,

n.] HYPNOTISM, SOMNAMBULISM, AND ALLIED STATEa 81

APPENDIX.

Some years ago there appeared in several American journals the
report of an extraordinary case of somnambulism — it was that of a
boy who, while in a state of somnambulism, had killed another boy.
But no exact scientific account of it was ever given, so far as I
know. In April of this year, however, an undoubted case of
somnambulistic homicide occurred in Glasgow, the account of which
has been published since the foregoing chapter was written.^ A man
named Eraser, twenty eight years of age, seized his child who was
in bed with him, and dashed its head against the wall or floor,
believing that he had seized a wild beast which had risen through
the floor and jumped upon the bed to attack the child. His wife's
screams awoke him, and he was horrified to find that he had fatally
injured his child, whom he was passionately fond of.

He was a pale and dejected looking man of nervous temperament,
dull, and somewhat childish, but able to earn his livelihood as a
saw-grinder, being a good workman. His mother had suffered
nearly all her life from epileptic fits, and had died in one ; her
father, whom Eraser was said to be very like, also died in a fit.
His maternal aunt and her son were both insane. His brother
died from convulsions in infancy, and his own child had been
dangerously ill from convulsions at one time. There was, therefore,
an unquestionable neurotic family history. Erom his earliest years
he had himself been troubled by bad dreams and nightmares, and
had often walked in his sleep. He was particularly liable to do
so after he had undergone excitement and agitation in the day.
For example, having a little sister whom he had often warned
against falling into the water, he got up in his sleep several times
and went down to the water-side, where he called her loudly by
name, and grasped with his arms as if he were rescuing her.
Sometimes he awoke, but sometimes went back to bed without
awaking. He remembered nothing about these nocturnal excursions
unless he was awakened at the time, but suspected he had made
one, in consequence of feeling weary and unrefreshed in the morning.
After his marriage in 1875 the attacks assumed a different

^ Journal of Mental Science^ Octobet, l^l^.

82 PATHOLOGY OF MIND. [chap. it.

character : a great terror would seize upon him, and he would start
out of bed under a vivid feeling that the house was on fire, that his
child was falling into a fit, that a wild beast of some kind had got
into the room ; roaring like an animal, he would drag his wife and
child out of bed in order to save them, or would chase the supposed
beast frantically through the room, throwing the furniture about,
and striking at it with any weapon he could lay hold of. He had
on different occasions seized his wife, his father, a fellow lodger by
the throat, and nearly strangled them, believing that he had got
hold of the beast. Puring the seizures his eyes were open and
staring ; and it was plain he saw and seized chairs or any con-
venient weapon, albeit he was blind to what was not in relation
.with his delusive ideas ; sometimes he could hear and answer
questions, speaking distinctly, at other times not.

It was in one of the attacks that he killed his child. His wife
was awakened by hearing him roaring and furiously dragging at
her ; he then leaped out of bed, and as she followed him, as she
used to do on these occasions, she heard him smashing something
against the wall, which she was horror-struck to find was the child ;
its skull was so severely fractured that it soon died. Awakened by
her cries, he showed the utmost distress, ran for water, roused the
neighbours, and hastened to fetch a doctor. Put on his trial for
murder, he was acquitted on the ground of being unconscious of
the nature of his act by reason of somnambulism.

The case much strengthens the opinion of old medical writers
that there is a close affinity between somnambulism and epilepsy.
In truth, looking to the history of epilepsy in the family, and to the
character of the nocturnal seizure, the latter might justly be looked
upon as a nocturnal epileptic fit, in which the discharge took a
mental instead of a motor channel, as we know to happen in some
cases of epilepsy during the daytime.

CHAPTER III.

THE CAUSATION AND PRETENTION OF INSANITY.

A. EtidogicaL

LThe causes of mental derangement, as they are usually de-
scribed in books, are so vague and general, so little serviceable
for use, that the knowledge of them yields us very little help
when we are brought face to face with a concrete case and
endeavour to gain a clear conception of its causation. The
impossibility of getting precise information arises in most in-
stances from the insuperable difficulties under which we are of
knowing a person's character and history fully, intimately, and
exactly. We cannot go through the complex and often tangled
web of his whole life, following the manifold changes and
chances of it, and, seizing the single threads out of which its
texture has been woven, unravel the pattern of it. No man
knoweth his own character, which is ever under his inspection :
how then can he know that of his neighbour, when he has only
brief and passing glimpses into it ?

Great mistakes are oftentimes made in fixing upon the
supposed causes of the disease in particular cases ; some single
prominent event, which was perhaps one in a train of events,
being selected as fitted by itself to explain the catastrophe.
The truth is that in the great majority of cases there has been
a concurrence of steadily operating conditions within and
without, not a single effective cause. All the conditions,
whether they are called passive or active, which conspire to the
production of an effect are alike causes, alike agents ; all the
conditions, therefore, which co-operate in a gjvevi c^^^ \cl ^^

84 PATHOLOGY OF MIND. [cuAr.

production of disease, whether they lie in the individual or in
his surroundings, must be regarded as alike causes. When we
are told that a man has become mentally deranged from sorrow,
need, sickness, or any other adversity, we have not learned much
if we are content to stay there : how is it that another man
who undergoes an exactly similar adversity does not go mad ?
The entire causes could not have been the same where the
cflects were so different. What we want to have laid bare is
the conspiracy of conditions, in the individual and outside him,
by which a mental pressure, inoperative in the one case, has
weighed so disastrously in the other ; and that is information
which a complete and exact biography of him, such as never yet
has been written of any person, not neglecting the consideration
of his hereditary antecedents, could alone give us. Were all
the circumstances, internal and external, scanned closely and
weighed accurately it would be seen that there is no accident in
madness ; the disease, whatever form it had, and however many
the concurrent conditions or successive links of its causation,
would be traced as the inevitable consequence of its ante-
cedents, just as the explosion of a train of gunpowder may be
traced to its causes, whether the train of events of which it is
the issue be long or short. » The germs of insanity are most
often latent in the foundations of the character, and the final
outbreak is the explosion of a long train of antecedent
preparations.]^

As the causation of insanity may thus reach back through
a lifetime, and even have its root far back in foregoing genera-
tions, it is easy to perceive how little is taught by specifying a
single moral cause, such as grief, vanity, ambition, which may
after all be, and often is, a prominent early symptom of the
disease which, striking the attention of observers, gets credit for
having caused it. I am apt to think that we may learn more of
its real causation by the study of a tragedy like Lear than from
all that has yet been written thereupon in the guise of science;
A great artist like Shakespeare, penetrating with subtle insight
the character of the individual and discerning the relations
between him and his circumstances, apprehending the order
which there is amidst so much seeming disorder, and disclosing

III. J THE CAUSATION AND PREVENTION OF INSANITY. 86

the necessary mode of evolution of the events of life, embodies
in the work of his creative art more real information than can
be obtained from the vague and general statements which
science in its defective state is compelled to put up with.

Life in all its forms, physical and mental, morbid and healthy,
is a relation ; its phenomena result from the reciprocal action of
an individual organism and of external forces : health is the
consequence and the evidence of a successful adaptation to the
conditions of existence, and imports the preservation, the well-
being, and the development of the organism, while disease marks
a failure in organic adaptation to external conditions and leads
to disorder, decay, and death. It is obvious that the harmonious
relation between the organism and its environment which is the
condition of health may be disturbed either by a cause in the
organism or by a cause in the environment, or by a cause, or
rather a concurrence of causes, arising partly from the one and
partly from the other. When it is said then that a person's
mind has broken down in consequence of adverse conditions of
life, social or physical, there is presupposed tacitly some infirmity
of nerve element, inherited or acquired, which has co-operated ;
were the nervous system in a state of perfect soundness, and
in possession of that reserve power which it then has to adapt
itself within certain limits to varying external conditions, it is
not likely that unfavourable circumst.ances would be sufficient
so far to disturb the relation as to initiate mental disease. But
when unfavourable action from without conspires with an in-
firmity of nature within, then the conditions of disorder are
established, and the discord, which a madman is, is produced.

It has been the custom to treat of the causes of insanity as
physical and moral, but it is not practicable to make the dis-
crimination in many cases. Where the existence of a hereditary
taint, for example, is the physical cause of some moral defect or
peculiarity of character which issues at last in insanity, one
writer, looking to the mental aspect, will describe the cause as
moral, while another, looking to the bad inheritance, describes
it as physical. Certainly,, where there is visible defective
development of brain in consequence of a bad inheritance, as in
idiocy sometimes, all persons are agreed as to the ^\v^^^ft^\3ka^^xxfe

86 PATHOLOGY OP MIND. [cuap.

of the defect; but when the cerebral defect is not gross and
patent, making itself known only by some vice of disposition,
most people will consider it to be of a moral nature. The
truth is, on the one hand, that in the great majority of cases in
which a so-called moral cause operates there is something in
the physical constitution which co-operates essentially, and, on
the other hand, that every moral cause operates in the last
resort through the physical changes which it produces in the
nerve-centres. These may be sudden and of the nature of a
commotion, as when a mental shock causes instant convulsion,
or 'paralysis, or madness ; or they may be gradual and of the
nature of organic growth, as when a fault of character grows
with a person's growth, until the balance of his mind is over-
thrown. It was set forth at almost superfluous length in the
first volume that thoughts, feelings, and actions leave behind
them residua which are organized in the nerve-centres, and
thenceforth so modify their manner of development as to con-
stitute an acquired nature, wherefore what we habitually feel,
think, and do foreordains in great part what we shall feel, think,
and do ; and as moral manifestations throughout life thus deter-
mine corresponding physical organization, it is evident that a
steadily acting moral cause of insanity is all the while producing
its physical changes in the occult recesses of the supreme nerve-
centres of mind. In fact the brain that is exercised so
regularly in a given manner as to acquire during health a
strong peculiarity or bias of action is sometimes more liable to
disorder in effect of this bias ; and when the disorder is produced
by an independent cause, the bias or habit will, according to its
good or evil character, help to overcome or to aggravate its
effect. When, for example, insanity is the consummate ex-
aggeration of a particular vice of character, the morbid symp-
toms mark a definite habit of morbid nutrition in the supreme
nerve-centres — a gradually effected modification of the mental
organization along a morbid line. On the other hand, the brain
that is exercised habitually in the best way acquires a strong
and healthy habit of thought, feeling, and volition, which
counteracts the effects of a morbid strain. On the whole,
perhaps, a man had more need to practise good habits than to

III.] THE CAUSATION AND PREVENTION OF INSANITY. 87

meditate sound principles, if it were a question between the
two ; but it is not, forasmuch as meditation on sound principles
is a preparation for the formation of good habits that have not
been taught.

With these preliminary remarks I go on to consider those
general conditions which are thought to predispose in some
way or other to insanity. In the outset I may make two general
assertions : that a man is what he is at any period of life,
first, by virtue of the original qualities which he has received
from his ancestors, and, secondly, by virtue of the modifications
which have been effected in his original nature by the influence
of education and of the conditions of life. But what a complex
composition of causes and conditions do these simple statements
import ! Hereditary predisposition is a general term which
connotes, but certainly does not yet denote, various intimate con-
ditions of which we know nothing definite ; we are constrained,
therefore, to deal in general disquisitions concerning it instead
of describing exactly its varieties and setting forth precisely the
laws of its action.

Heredity. — Whether it be true or not, as is sometimes said,
that no two leaves nor two blades of grass are exactly alike,
there can be little doubt that no two persons in the world are
now or ever have been exactly alike. However close the re-
semblance between them, each one has some characteristic
marking his individuality which distinguishes him from every-
body else, and which affects the course of his destiny. By the
circumstances of life the development of this intrinsic quality
may be checked in one direction or fostered in another direction,
but it can never be got rid of ; it is always there, a leaven
leavening the whole lump. In olden times it was attributed to
the influence of the particular star which was in ascendant at
the time of the mortal's birth ; but the blow to that easy theory
of causation was that twins born tinder the same planetary
influence sometimes evinced very different dispositions : the two
twin-sisters of Hungary, who were united by the bottom of
their backs and had the same blood, were of extremely different
temperaments, and the last years of the Siamese twins were
made miserable by the quarrels arising from tha A\Set^Ti\» \asKfe^

5

88 PATHOLOGY OF MIND. [cbat.

of the brothers, and the dififerent views which they took of the
American Civil War.

Whence comes this individuality of nature ? Without doubt
it comes from the same source as the individuality of bodily
conformation, of gait, of features — that is to say, from ancestors.
There is a destiny made for each one by his inheritance ; he is
the necessary organic consequent of certain organic antecedents ;
and it is impossible he should escape the tyranny of his organi-
zation. All nations in- all ages have virtually confessed this
truth, which has affected in an important manner systems of
religion, and social and political institutions. The institution of
caste among the Hindoos owed its origin to it ; and there can be
little doubt that the philosophy of that large sect among them
which taught the perpetual re-birth of mortals and the develop-
ment in this life of the deeds done in a former state of being,
holding the antecedent life of a being to be his destiny, was
founded on a recognition of hereditary action — of the fact that
the present nature has descended from the past by regular laws
of development or of degeneration. The dread, inexorable
destiny which plays so grand and terrible a part in Grecian
tragedy, and which Grecian heroes ai*e represented as struggling
manfully against, knowing all the while that their struggles
were foredoomed to be futile, embodied an instinctive perception
of the law by which the sins of the father are visited upon the
children unto the third and fourth generations. Deep in his
inmost heart everybody has an instinctive feeling that he has
been predestined from all eternity to be what he is, and could
not, antecedent conditions having been what they were, have
been different. It was a proverb in Israel that when the
fathers had eaten sour grapes the children's teeth were set on
edge ; and Solomon justly proclaimed it to be one of the virtues
of a good man that he left an inheritance to his children's
children. In village communities, where the people remain
stationary, and where the characters of fathers and grandfathers
are remembered or are handed down by tradition, peculiarities of
character in an individual ai'e often attributed to some here-
ditary bias, and so accounted for : he got it from his fore-elders,
it is said, and the aberration has allowance made for it.

in.] THE CAUSATION AND PREVENTION OF INSANITY. 89

In modem days we hardly take due account of this great truth
which ancient sages recognised, and wliich the experience of all
ages has confirmed, but it is vastly important to us, if we would
do well for our race, to acknowledge and confess it: we are deter-
mining in our generation much of what shall be predetermined in
the constitution of the generation that will come after us, and it
depends greatly upon us whether it shall be well or ill with it.
Certainly no one has power to change materially the funda-
mental tendencies of his own nature ;* the decrees of destiny
have gone forth, and he cannot withstand nor reverse them;
but if he contends manfully against bad impulses, as the hero
of Greek tragedy who, in the grasp of fatality and foredoomed
to failure, abated no effort to win an impossible -victory, he will
by degrees modify his character in part, and at any rate he will
do that which, being embodied as an aptitude in the constitu-
tion of his posterity, may happily be a stay and present help to
them in time of trouble and temptation. His efforts to over-
come what he cannot overcome successfully may haply endow
their natures with strength to be victorious in a similar struggle,
his pains being their gain, his sowing their harvest.

The least observation of a young child's mind, as its faculties
are unfolded by education, shows how much it owes to here-
ditary action. How easily does a well-bom European child
learn in a short time what, were it not that it has in its consti-
tution the benefit of ages of human culture — the quintessential
abstract thereof, so to speak — it would not learn in years, if it
ever learned at all! Just as it inherits muscles suited to
perform particular movements, and ready, after a little train-
ing, to perform them with ease, so it inherits in its brain
nervous substrata that embody the acquisitions of the culture
of its kind, and are ready, after a little training, to discharge the
function which has determined their formation through the gra-
dual experience of the race from age to age. Whoever doubts
this, let him take the child of an Australian savage and the child
of an ordinary European parent, and let him bestow the same
pains to give them the same education ; in the one case he will
find that he is playing upon a complex instrument, culture-
tuned, and ready to give forth harmony on \,\v^ oc,^"^\ssv3l ^*l %»

90 PATHOLOGY OF MIND. [chap.

suitable touch, and in the other case that he has to do with a
very imperfect instrument, harsh and untuned, out of which he
can only get a few notes, and never the highest notes, with all
the skill that he can employ.

I might say, perhaps, that every human being has four
natures — his animal nature, his human nature, his family
nature, and his individual nature. Beneath the individual
characteristics lies the family nature, so that it will happen
that in two brothers whose every feature differs we perceive
intuitively the family identity — a fundamental identity in
diversity, and, on the other hand, in two strangers who are very
like in features we perceive intuitively a fundamental differ-
ence, albeit we cannot describe it in words. Beneath the family
nature is the more general human nature, and beneath that
again the still deeper lying and more general animal nature,
which, long way as man is from his nearest of animal kin, has
by no means been worked out of him. Here we have to do
only, but enough to do, with the inheritance of the family.

Many familiar examples go to prove that a person inherits
not only the general characters of the family, but pecu-
liarities of manner and of disposition : tricks of thought, like
tricks of manner, moods of feeling like humours of body, are
inborn and come out usually at one period or another of his
life. Not only are the ways and looks of immediate ancestors
thus reproduced sometimes, but those of ancestors who are
remote and not perhaps in the direct line of descent ; it
would seem in fact that every parent has latent in him the
abstract potentialities of his ancestors, for I know not how
many generations back along the line of descent, and that
these may undergo development again in his posterity if they
chance to meet with suitable stimuli. To understand what
these latent potentialities are, he would do well to study their
developments in father, brothers, sisters, uncles, children — ^in
all branches of the family tree : explicit in them he shall
read what is implicit in himself. And here I may fitly take
notice that inherited qualities shall appear only at certain epochs
of life, the ancestral nervous substrata being then stirred to
function for the first time. At puberty, for example, a bodily and

III.] THE CAUSATION AND PREVENTION OF INSANITY. 91

mental revolution takes place, new mental substrata are aroused
to function, and ancestral characters show themselves which were
not noticed before, and probably never would have been noticed
had the person been made a eunuch ; during pregnancy there
may be distinct manifestations of her mother's character in a
daughter which no one had observed before ; and at the change
of life, when a woman's special functions are over, and she tends
towards a masculine character of body and mind, there may be
evinced peculiarities which call to mind a male ancestor. It is easy
to understand that particular experiences in life may, like these
changes in the bodily evolution, be fitted to awaken to function
latent or quiescent ancestral nervous substrata, and that in this
way the accident of an accident in life may chance to bring out
an ancestral character which otherwise, like a seed not brought to
bear, would have remained dormant. As it is with the origin
and the decay of instincts among animals, so it is with the
development and the decadence of these ancestral nervous sub-
strata: conditions of life suited to their activity will stimu-
late them to action and will foster also the development of new
adaptive tendencies with their appropriate substrata ; conditions
of life unsuited to their activity will cause by degrees the
waning and the ultimate disappearance of old tendencies with
their substrata. In this way a slow evolution takes place through
the ages, and the thoughts of men are gradually transformed.
One consideration more with respect to an individual's legacy
from his parents : he inherits not only their general family nature
and their original individual nature, but something from their
individual characters, as these have been modified by their
sufferings and doings, their errors and achievements, their
development or their degradation. Thus the work of one
generation with its consequences, good or ill, is continued in the
constitution of the next generation, living on in it, and the life
of a person is the unbroken continuation of the life of his
forefathers. No wonder that men have invented doctrines of
predestination and metempsychosis.

Very little observation, however, is needed to show that the
reproductions of the qualities of ancestors is but one side of
the action of heredity — that it does not copy "Dierd^^ ^ \sv\\» ^^^

:cu^^

I

PATHOLOGY OP MIND. [t

invents ; so that an individual often exhiUts marked differences
from any known ancestor. Its operation include3 a law of
variation as well as the reproduction of the like. It is true it
might be said that the variiitions which an individual presents
tire not what they seem, but repetitions of qualities of remote
ancestors who have been forgotten, but it is an assertion which
is opposed to what we know of the correlations between variety
of character and increasing complexity of social conditions, and
to the evident fact that men in the long nin advance by evolu-
tional variations upon what they have inherited from their
forefathers, or go back upon it by retrograde morbid varieties.
The existence of different moral dispositions and intellectual
capacities in twins and in double monsters is suEBcient proof
that hereditary action is not of the nature of a mere
mechanical copy ; it is rather of the nature of a complex
chemical combination, whereby compounds not resembling in
properties their constituents are oftentimes produced. Un-
happily we are yet as ignorant of the laws by which combina-
tious of germinal elements take place and of the manifold varia-
tions of products which ensue therefrom, as people of old
■were of the combinations of chemical elements and of the com-
plex chemical products which result from them. Nature builds
up a multitude of different complex chemical products out of
a few simple elements ; it can be no cause of surprise then
that out of the combinations of the highly complex organic
bodies which the sperm and the germ elements are she builds
up all the varieties of individual cJiaracter. Consider the com-
plexity of these germinal elements ! There is not an organ of
the parent's body, we have reason to think, not a tissue of which
an organ is formed, not an element probably of a tissue, which
lias not its idiosyncrasy represented in the minute germ in some
latent and mysterious way, and which may not therefore come
out in its full traits of character in the developed oflspring ; or,
it it does not come out in its own character, serve to neutralise,
supplement, or modify some quality in the combining germ
from the other parent. Moreover, if it is neither developed
after its own kind nor utilised in combination, it may lie com-
pletely dormant in that generation and come out in the off-

III.] THE CAUSATION AND PREVENTION OF INSANITY. 93

spring's offspring, or even in a later generation ; for we know not
in the least how long it may remain latent before it is extinct.

This skipping of one generation and reappearance in a suc-
ceeding one has been called Atavism, and has excited surprise
when it has been observed in morbid heredity : it is so striking
sometimes in insanity that Ludovicus Mercatus, a Spanish phy-
sician, who wrote a book on hereditary diseases, was of opinion
that the insanity appeared in every other, or every third, indi-
vidual in lineal descent. But it is not so extraordinary as it
seems; for we have a familiar physiological instance of the
same thing when a daughter of a house transmits to her son
any of the special masculine qualities of her family, which of
necessity cannot be developed in her body, or when a son of the
house transmits to his daughter any of the special feminine
qualities of his family. In these cases the special sexual
qualities must have been latent in the intermediate generation.
Other qualities, healthy and morbid, that are not bound to sex
may in like manner be latent in a generation, if they meet not
in the circumstances of the individuaVs life with the conditions
fitted to stimulate them into active display. We assume them
to be latent when they do not show, but of course we cannot
really say that they are then perfectly inactive ; they may, for
anything we know, be held in check by, or hold in check, some
quality of the combining germ from the other parent, or have
entered into combination with it to form a new product with
qualities different from either of its constituents. Organic com-
bination being a matter of such exceeding complexity of
elements, of the nature and laws of union of which we have
not at present the least notion, but in comparison with which
we may be sure the most complex chemical combination known
is simple, we see reason enough why children are not mere
stereotyped copies of their parents, but always exhibit in
their mental and bodily constitutions and features more or less
distinct evidence of a law of variation.

Not only have we to take note of the complex character of
organic combinations, but we ought further to note that com-
bining germs may be well or ill-fitted to combine, being in the
one case of such a character as to make & stioiv^ wA ^\a^^

94 PATHOLOGY OF MIND. [chap.

compound, and in the other case of a character to make a feeble
and unstable compound. These greater or less affinities of the
formative germs for one another I take to be a necessary conse-
quence of the observation that two persons may be very well
suited or may be very ill suited to produce healthy offspring ; for
we may look on the germs as the essential abstracts of the indi-
viduals from whom they proceed, containing in the innermost all
that is explicitly displayed in features of body and mind, and
exhibiting the affinities and repulsions which the individuals
exhibit. It was an Oriental idea that a complete being had
in primeval times been divided into two halves, which have
ever since been seeking to join together and to reconstitute the
divided unity. The desire and pursuit of this unity is love,
and it is accomplished in the happy union of the sexes, and in
the production of the new being who proceeds therefrom.
Clearly the completest attraction ought to exist between the
individuals ; for if there be indifference or repulsion, as happens
sometimes where interest instead of affection makes a marriage,
there cannot be that full and harmonious co-operation of all the
conditions which is necessary to the best propagation ; not that
elective affinity by which two beings are drawn together and
combine in marriage, like two elements in nature, to form a stable
compound. As good an author as Burdach maintained that the
beauty and ugliness of children were not dependent so much
upon the beauty and ugliness of their parents as upon the love
or aversion which they had for one another ; and to this opinion
Lucas heartily subscribes. One would have hesitated less to
assent to it had it referred mainly to beauty and ugliness of
moral character ; for an ugly and unhallowed union of antipa-
thies can hardly fail to have consequences in the inexorable
logic of natural law.

All men are of the same species, and yet the varieties are so
great that the extremes do not combine well together ; if a man
of the highest civilised race has intercourse with a woman of
the lowest race, the probability is that the intercourse is sterile,
or if there chance to be offspring it is so much the hybrid
that it is itself infertile. Degenerate or morbid varieties
of civilised races evince a similar incapacity of procreation ;

111.] THE CAUSATION AND PREVENTION OF INSANITY. 95

sterile idiocy being the natural termination and extinction of
degenerate varieties of the human kind. In vain might the
most curious despot attempt to propagate a race of idiots. These
extreme instances of a positive unaptness or repugnance of germ
elements to combine will serve to bring home to the mind the
conception of the existence of laws of combination which are
in constant operation, and which we are yet ignorant of, though
we may expect them to be known some day. Is it not easy to
conceive that, without being so incompatible as to actually refuse
to combine, the germ elements may be 'so far unsuited to one
another that when they combine they do so in a half-hearted way
and produce an unstable compound ? One frequently sees an
illustration of this in the outbreak of insanity in the offspring
of parents, one or the other of whom has been insane at some
time, and I believe it to be the explanation of the distinct pre-
disposition to insanity which appears, so far as the parents are
concerned, to be generated de novo in the offspring ; they may
not themselves have ever been insane, nor may they come from
families that have any marked taint of insanity, yet they may,
by reason of their mental or bodily characters, be as unfitted to
breed together successfully as if they were positively insane.
If the popular notion be true, which the instincts of all nations
seem to confirm, that consanguineous marriages breed degenerate
offspring, the case is one of this kind : germs subsuming the
qualities of the same ancestors, with such little admixture of
new elements as may chance to come from the non-related
parents, lack the variety of composition which is necessary to
the best combinations, and so are unfitted to produce a stable
compound. Any one who will may make the observation that
when two persons of narrow and intense temperament, having
great self-feeling, distrustful of others,* and prone themselves to
cunning ways and hypocritical dealings, mean in spirit as in
habits, perhaps deceiving themselves all the while by an in-
tense affectation of religious zeal of evangelical, ritualistic, or
other extreme type, unite in marriage and have children, they
lay the foundations of insanity in offspring more surely often
than an actually insane parent does. In truth there are certain
varieties of temperament which, not reaching t\i^ Ae.^^^ <^^

96 PATflOLOGY OF MIND. [chap.

insanity, but tending more to criminal type, are as likely by their
union to generate it as is the most positive mental derange-
ment in one or other of the parents ; and foremost amongst
them I hesitate not to place the union of essentially false and
hypocritical natures.

It is a common belief that genius is seldom inherited, and
it is certainly true that many wise men have had foolish sons,
and that many distinguished men have proceeded from common
and unknown families. One writer has gone so far as to declare
that giants in mind, likfe giants in body, are unfruitful. One
may conceive the reason why these extraordinary developments
of mind or body are not inherited to be because^ they are extra-
ordinary varieties ; being acquired rather than natural characters
of organization, so far therefore special deviations from the type,
they are less likely to be inherited than is some family character
which belongs to the stock, goes along with it in all its individual
outcomes, and requires no special external conditions to aid its
development. There is a repugnance in nature to extreme
deviations from the type, and when such a deviation has occuiTcd
the tendency is to revert to the ordinary type. Monsters deviate
so far from the normal type that they are either not viable or
cannot propagate themselves ; so it is with actual diseases, which
are truly morbid varieties ; they are not propajgated as actual
diseases when they do descend from father to son, but as ten-
dencies to disease, and they are likely to be extinguished eventu-
ally in that line of descent, either by the operation of the
constant disposition which the organism shows to revert to a
sound type, or, if they get the better of the healthy forces, by
their increase until they put a stop to propagation. Mr. Galton,
who wrote a book to prove that genius is hereditary, counting
among his many examples hardly more than two or three cases
of true genius, has since perceived that all extraordinary
characters in families tend to revert to mediocrity, whether the
deviation be in the direction of plies or mimis, and that in a
generation or two this reversion is to the equilibrium from which
the family variability had deviated. If it be true that genius
is apt to be infertile, as the giant certainly is, we must
suppose that the deviation from the common type has been so

111.] THE CAUSATION AND PREVENTION OF INSANITY. 97

great as to render the germ incapable of combination with a
germ that is cast in the common mould, and that so nature at
once prevents by strong measures, as she does in the case of
idiocy, the necessity of a gradual return in the course of genera-
tions to the average standard of mediocrity. Were genius in-
heritable the result would soon be the development of a higher
species of man separating itself widely from a lower species.

In the pathological action of the law of variation or invention
of which I have spoken we have an explanation of the de novo
production of a predisposition to insanity, which must manifestly
have taken place once, and which takes place now from time to
time. Were all madness swept from the face of the earth to-
morrow, past all doubt men would breed it afresh before to-
morrow's to-morrow. Two subjects concerning which information
may be set down as wanting, and which urgently need exact
investigation at the present time, are (a) The different ante-
cedent conditions of the generation of a predisposition to in-
sanity ; and (&) The different signs, mental and bodily, by
which such a predisposition betrays itself Of the latter I
shall treat in due course ; respecting the first, when it comes to
be studied seriously, I may note that besides the law of variation
which is manifested in the results of the combinations of germ-
elements, we shall have to take account — secondly, of the un-
questionable influence of the particular mental and bodily state
of one or both parents before and at the time of propagation ;
thirdly, of the important influence upon the child's constitution
which is exerted for good or ill by the mental and bodily state
of the mother during gestation ; and, fourthly, of the influences
brought to bear upon the chUd during the first years of growth
and development of its susceptible nervous system. The
neutralization of a tendency to insanity, through which it comes
to pass that it sometimes becomes extinct, is due, first, to the
favourable influence of a happy marriage, that is to say, one
which is antagonistic, not consentient, to its development, and
secondly, to the beneficial effect of conditions of life suited to
check its development. There is yet a third weighty cause to
be taken into accoimt, namely, the natural tendency of the
organism to revert to the sound type. Were \\» wo\» l«^ '^^^^

98 PATHOLOGY OF MIND. [chap.

hygienic agencies all the world must become mad sooner or
later. But as a matter of fact, in the unceasing flow of the
stream of life ill tendencies are being, constantly formed and
unformed, as chemical compounds are formed and unformed.

I go on now to consider the meaning of insanity as an
aberrant phenomenon in nature and of the general conditions
which lie at its foundation, before entering upon the discussion
of its particular causes. Aberrant or abnormal, as it may be
thought and called, it comes by law, and is just as natural* as the
normal phenomena of sanity. It is the clear business of man
in the world to adapt himself to the surrounding conditions of
his existence and to profit by them. The gradual increase of
knowledge and skill, which we call progress of science and art, is
the gain which he makes as he succeeds in more close and exact
adaptation to external nature by means of improved methods
of observation of it and corresponding action upon it. The
mechanical conquests of the age are no more than systematic
improvements of what we do in consequence of more accurate
and systematic observation of what we have to do with : we
observe in order to foresee, and foresee in order to modify and
direct, so gaining victories through obedience. Progress in
physical science and in the arts which are based upon it is made
then by gating into closer and closer harmony with nature and
by informing our actions with the insight so gained — ^by making
them, in fact, a developmental advance upon nature. Progress
in poetry and in fine art has the same basis and should have
the same aim — to get closer insight into the beauties and har-
monies of nature and to construct new art combinations which
shall be a development of them — to make nature better by
human means, the means itself being still nature. To bring
self by systematically improved adaptation of feeling, insight
and doing into the most intimate possible harmony with nature,
so as almost to lose the sense of self in the larger sense of
oneness with it, must be the means, I take it, and should be
the aim, of human evolution. Failure in this aim, when it falls
below a certain level, is punished by manifest degeneration and
disease ; for nature is sure to take vengeance upon those who
ignore or transgress its laws, observing not its commandments

III.] THE CAUSATION AND PKEVENTION OF INSANITY. 1)9

to do them. Certainly it would not be well for any one to
mortify self so far as to get a disdain of it, for he might not then
care to strive at all ; he will find that to do the best for himself
and to do the best for nature are one, and that the highest re-
sults of his wisest striving culminate in a more or less complete
self-surrender — in a nearer and nearer approach to Nirwana.

Inasmuch as a large part of the nature with which man has
to come into some sort of harmony is not what we call physical
nature, but human nature, it is plain that a main business of
his life will be to adjust his relations to his kind. That he
cannot help doing in the rudest form of primitive society ; the
control of his own passion from fear of the recalcitrant kick
of his neighbour's passion is a solid foundation of a primitive
sort of social feeling ; but in a higher development of the social
organism his relations as a social element become much more
complex and special Sympathy with his kind and well-doing
for its welfare, direct or indirect, are the essential conditions of
the existence and development of the more complex social
organism ; and no mortal can transcend these conditions with
any success. Let him feel, as he well may, that the play of
human life is a dreary farce, that he and his fellow- workers are
but a little higher than the brutes, and like the brutes will
soon perish everlastingly — that all in the end is vanity and
vexation of spirit, he must still feel and work with his kind if
he would have health of mind. Misanthropy is commonly
madness in the making. Hence it is that humour, which always
is imbued with sympathy, is a higher and more wholesome
quality than cynicism, which is always inspired by contempt.
If an individual fails to bring himself into sympathetic
relations, conscious or unconscious, with surrounding human
nature, he becomes a sort of discord, and is on the road, though
he may not reach the end of it, which leads to madness or to
crime: he may be likened unto a morbid element in the
physiological organism, which cannot join in function with the
surrounding elements, is an alien among them, and must either
be extruded from it or be made harmless by sequestration in it :
he is truly an alien from his kind, and with equal truth he is
said to be alienated from himself, because it ia t\\^ i\\xvsi\Asya. <^\ ^

100 PATHOLOGY OF MIND. [chap.

normal self to be one with its kind. Eccentricities of character,
when they are not counterbalanced by a strong judgment, are
apt to ripen into insanity either in the individual or in his
offspring, and the most appalling crimes of which history keeps
record, deeds of horror at which the world turns pale, have been
perpetrated by those who, having gained or inherited authority
and power, were so entirely emancipated from the social bonds
of human feeling as to be sometimes veritable madmen. A
scientific view of the conditions of human evolution simply
brings us back to the old story which prophets have seen and
proclaimed — to obey the commandments of God as they are
written in the laws of nature, and to love one's neighbour as
oneself, to conform humbly, that is, to physical and social laws.
If it be true that it is the aim and the condition of a just
development to bring the individual into sympathetic relations
with the sufferings and the doings of his kind, it is plain that
he who, distrustful of every one, pursues eagerly his own selfish
schemes, having no regard to his altruistic functions as a unit in
the social organism, must be on the road to initiate degeneracy of
some kind. Intense egoism of this sort does in fact divide into
two main branches, as the degeneracy increases through genera-
tions— namely, the insane and the criminal types, each of which
has its various subdivisions. That the children's teeth are set on
edge when the fathers have eaten sour grapes was not the mere
dream of a seer's fancy, but the piercing insight into a natural
law by which degeneracy increases through generations. Crime
and madness are the active outcome of antisocial tendencies.
It is well known how hard a thing it is sometimes to distinguish
between these two forms of human degeneracy. There are, on
the one hand, many criminals who exhibit such evident signs of
defect or unsoundness of mind that it is impossible to say con-
fidently whether they ought to be sent to an asylum or to a
prison ; and, on the other hand, there are insane persons who
evince such criminal and vicious tendencies that one cannot help
feeling that the discipline of a prison would be the best treat-
ment for them : both proceed in descent from the same anti-
social stem, and it is no wonder that their varieties intermingle
JnaistinguishMy in the borderland where they touch.

m.] THE CAUSATION AND PREVENTION OF INSANITY. 101

Those who have had much to do with the treatment of
insane persons have not failed to note the marked mental pecu-
liarities of their near relations in many instances, and to lament
that they oftentimes show themselves more distrustful, more
difficult to reason with, more impracticable, than the member of
the family who is confessedly insane. In the first place, they
have such an intimate radical sympathy of nature with those
tendencies of character which have culminated in insanity in him,
that they cannot sincerely see alienation which is patent to all
the rest of the world : they will minimise bit by bit, finding
reason or excuse for each strange act, feeling, or idea, until they
have accounted for all the strangeness of it, and it only remains
for the patient listener to confess that the palpable madness was
after all very natural in him, and that their relative is not mad
like other mad persons, or at any rate that what would be great
madness in all the rest of the world is not madness in him.
In the second place, as a consequence of their essential likeness
and sympathy of nature, they will question, dispute, carp at
every restraint which those under whose care he is may find it
necessary to place upon him; notwithstanding that they may
have been obliged to send him from home and to put him under
control because he was an intolerable trouble or an actual
menace and a danger, they will talk as if they would exact a
mode of treatment which entirely ignored his insanity, and will
end probably, if he does not get better, in the firm belief that
his disease has been caused and kept in action by the improper
treatment to which he has been subjected. The worst of them
would risk the chance of his attendant being killed by a lunatic
rather than suffer what they call his sensitive disposition to
be hurt by the necessary means of control, and if such a cata-
strophe happened their genuine sympathies would be with
him, not with the victim of his violence. Their intensely
suspicious and distrustful natures, their tortuous habits of
thought, their wiles and insincerities, their entire absorption in
a narrow selfishness, mark a disposition which is incapable of
coming into wholesome relations with mankind; it is of a
character to lead to guile in social intercourse, to petty fraud in
business, and, when the conditions of life a\^ \v«?cvi vlw^ \fc\xi^\*

102 PATHOLOGY OF MIND. [chap.

to evil-doing, even to crime, and which in any case is pretty
sure to breed insanity or crime in the next generation. Moral
feeling is based upon sympathy; to have it one must have
imagination enough to realise the relations of others and to
enter ideally into their feelings ; whereas these persons have
not the least capacity of going in feeling beyond the range of
their family, unless it be to embrace a favourite cat or dog, and
are governed by an intense and narrow family selfishness.
They are capable sometimes of an extraordinary self-sacrifice for
one another within that small circle, but they are completely
shut up within it. Being in such slight and unstable relations
with their kind, what wonder that a son or daughter who has
descended from such an unsound stock, and who most likely
sucked in suspicion and egoism with the mother's milk, should
get so far astray as to be loosened from wholesome bonds of
social relation and to become insane or criminal !

Good moral feeling is to be looked upon as an essential part
of a sound and rightly developed character in the present state
of human evolution in civilised lands ; its acquisition is the
condition of development in the progress of humanizcUion.
Whosoever is destitute of it is to that extent a defective being ;
he marks the beginning of race -degeneracy ; and if propitious
influences do not chance to check or to neutralize the morbid
tendency, his children will exhibit a further degree of degeneracy
and be actual morbid varieties. Whether the particular outcome
of the morbid strain shall be vice, or madness, or crime, will
depend much on the circumstances of life, but there is no doubt
in my mind that one way in which insanity is generated de
novo is through the deterioration of nature which is shown in
the absence of moral sense. It was the last acquisition in the
progress of humanization, and its decay is the first sign of the
commencement of human degeneracy. And as absence of moral
sense in one generation may be followed by insanity in the
next, so I have observed that, conversely, insanity in one
generation sometimes leaves the evil legacy of a defective moral
sense to the next. Any course of life then which persistently
ignores the altruistic relations of an individual as a social unit,
fvhjch is in truth a systematic negation of the moral law of

III.] THE CAUSATION AND PREVENTION OF INSANITY. 103

human progress, deteriorates his higher nature, and so initiates
a degeneracy which may issue in actual mental derangement in
his posterity.

When we make a scientific study of the fundamental meaning
of those deviations from the sound type which issue in insanity
and in crime, by searching inquiry into the laws of their genesis,
it appears that these forms of human degeneracy do not lie so
far asunder as they are commonly supposed to do. Moreover,
theory is here confirmed by observation; for it has been
pointed out by those who have made criminals their study that
they oftentimes spring from families in which insanity, epilepsy,
or some allied neurosis exists, that many of thfem are weak-
minded, epileptic, or actually insane, and that they are apt to
die from diseases of the nervous system and from tubercular
diseases. (One might venture to describe, and to place side by
side as having near relations to one another, three neuroses — the
epileptic, the insane, and the criminal neurosis — each of which
has its corresponding psychosis or natural mental character.j
In like manner as the form of every living creature answers to
its habits, it desiring only what it can* attain by means of its
organs, constructed as they are, and its organs never urging it to
that which it has not a desire for, so it is with the particular
neurosis of that congeries of nerve-centres which constitute
specially the organ of mind ; it inspires a desire for and deter-
mines a tendency to that form of mental activity, in other
words, to that development of the psychosis, which is the fullest
expression of its function. The sufferer from any one of these
neuroses represents an initial form of degeneracy, or a com-
mencing morbid variety, of the human kind, and life to him
will be a hard struggle against the radical bias of his nature,
unless he minds not to struggle and leaves it to the free course
of a morbid development. He is sadly weighted in running the
mce that is set before him, since he has an enemy in his camp,
a traitor in his own nature, which is ever ready to conspire with
external adversities, and often lends them a secret help, without
which they would be powerless to overcome him.

When the criminal inmates of a prison are studied, as they
need to be more scientifically than they have yei b^^Iv^^J^K^ ^x^

104 PATHOLOGY OF MIND. [chap.

not found to be quite so much alike as a common name would
imply ; indeed, they may rightly be divided into three principal
classes^ — (a) the first class, consisting of those who, not being
really criminally disposed, have fallen in consequence of the ex-
traordinary pressure of exceptionally adverse circumstances;
(b) the second class, of those who, having some degree of criminal
disposition, might still have been saved from crime had they had
the advantages of a fair education and of propitious conditions
of life, instead of the disadvantages of an evil education and of
criminal surroundings ; (c) the third class, of bom criminals,
whose instincts urge them blindly into criminal activity, what-
ever their circumstances of life, and whom neither kindness,
nor instniction, nor punishment will reform, they i*eturning
naturally to crime when their sentences are expired, like the
dog to its vomit or the sow to its wallowing in the mire. It
illustrates the strength of the instinctive repugnance to anti-
social beings that while compassion is oftentimes felt for a
criminal of the first class, and apology made for his crime, not
the least pity is felt nor the least allowance made for the
fearful tyranny of his* bad organization under which the
criminal of the third class groans and succumbs. Clearly
society might justly commiserate the criminal at the same time
that it deliberately punished him by sequestration for its own
certain protection and for his possible reformation.

In this relation it is interesting to note how much a desire of
concealment and a feeling of disgrace still attach to the occurrence
of insanity in a family, despite all that may be said with regard
to its nature as a defect or a disease calling for compassion.
The feeling has at bottom a certain justification in the truth
that insanity is a mark of family degeneracy, the initiation of a
morbid variety of the human kind, a proclamation of failure in
adaptation to the complex social and physical conditions of
civilised life. The sufferer is an outcast from the social system,
being unable to conform to the laws which govern social organi-
zation and function. There always has been, and for a long
time to come there will no doubt still be, a feeling of distrust
of and repugnance to the anti-social unit who has fallen from
bis high rational estate as a being who can feel, think, and act

III.] THE CAUSATION AND PREVENTION OF INSANITY. 105

with his kind, and whose thoughts and deeds are incompatible
with the social well-being ; he will lie under a social ban, and
the family to which he belongs will feel the reflected stigma.

The foregoing considerations make it plain that if all sorts
and conditions of insanity were swept clean from the face of
the earth at one stroke, so that hereditary predisposition could
not work as a factor in its production, no long time could
elapse before a new start was given to one or other of its forms
of degeneracy. It is a mere question of time when a deviation
from the laws of social well-being shall reach such a pitch that
the individual who is the outcome is unfit to take his place and
perform his functions as a social element, and must be treated
as a morbid variety ; degeneracy of the moral being must ensue
in consequence of a persistent disregard of these laws as surely
as disease or death of body will ensue from a persistent disregard
of the laws of physical health ; and he who is going the way
of degeneracy from the ideal type of wholesome manhood
plainly cannot help, but will hinder that evolution of the social
organism which, as it is the effect, we may t^ke to be in the
purpose, of nature's development. All those who are going this
downward way, along whatever special path, we might class
together under the head of anti-social elements ; there would
be many varieties of them, ranging from the first beginnings
of degeneracy to the extremest forms thereof.

It would not perhaps be too absolute a statement to make —
That one of two things must happen to an individual in this
world if he is to live successfully in it : either he must be
yielding and sagacious enough to conform to circumstances, or
he must be strong enough, a person of that extraordinary
genius, to make circumstances conform to him. If he cannot
do either, or cannot manage by good sense or good fortune to
make a successful compromise between them, he will either go
mad, or commit suicide, or become criminal, or drift a helpless
charge upon the charity of others.

Having thus set forth the meaning of insanity as an aberrant
phenomenon in the social organization, and so hinted at the
conduct of life which is best suited to prevent it, 1 go on now
to treat more particularly of that definite pTed\?>^o^\\ACT£i \»^ S^.

106 PATHOLOGY OF MIND. [chap.

which is produced hy similar or allied disease in one or other of
the immediate ancestors.

Morbid Heredity, — ^This is a subject respecting which it is
not possible to get exact and trustworthy information. So
strong is the feeling of disgrace attaching to the occiUTence of
insanity in a family, and so eager the desire to hide it, that
persons who are not usually given to saying what is not true
will disclaim or deny ostentatiously the existence of any here-
ditary taint, when it is known certainly to exist or is betrayed
plainly by the features, manner, and thoughts of those who
are denying it. Not even its prevalence in royal families has
sufficed to make madness a fashionable disease. The main
value of the many doubtful statistics which have been collected
by authors in order to decide how large a part hereditary taint
plays in the production of insanity is to prove that with the
increase of oj)portunities of obtaining exact information the
greater is the proportion of cases in which its influence is
detected ; the more careful and exact the researches the fuller
is the stream of hereditary tendency which they disclose.
Esquirol noted it in 150 out of 264 cases of his private patients ;
Burrows clearly ascertained that it existed in six-sevenths of the
whole of his patients ; on the other hand, there have been some
authors who have brought the proportion down as low as one-
tenth.^ Some years ago I made a tolerably precise examination
of the family histories of fifty insane persons taken without
any selection ; there was a strongly marked predisposition in four-
teen cases — that is in 1 in 3*57, and in ten more cases there
was sufficient evidence of family degeneration to warrant more
than a suspicion of inherited fault of organization. In about
half the cases then was there reason to suspect morbid predis-
position. I have recently inquired into the histories of fifty

more cases, all ladies, the opportunities being such as could only

•

^ Elaborate statistical tables which have been gathered from public
asylum reports, in order to exhibit the proportions of instances in which
hereditary predisposition has existed, have never been of any value, except
so far as they served to occupy or amuse those who were at the pains to
compile them ; only where the inquirer is brought into the most intimate
relations with the friends of the patients can he make an approach to
accuracy, and even then it will be an approach only.

ni.] THE CAUSATION AND PREVENTION OP INSANITY. 107

occur in private medical practice, and with these results : that
in twenty cases there was the distinct history of hereditary pre-
disposition ; in thirteen cases there was such evidence of it in
the features of the malady as to beget the strongest suspicion
of it ; in seventeen cases there was no evidence whatever of it.
In the second fifty cases my opportunities of getting informa-
tion were more favourable in consequence of more frequent pei^
sonal intercourse with the fridids, and it sometimes happened
that the information sought foi was obtained quite accidentally
after heredity had been denied.1 What is the exact proportion of
cases in which some degree or kind of hereditary predisposition
exists must needs be an unprofitable discussion in view of the
difficulty and complexity of the inquiry ; suflBce it to say broadly
that the most careful researches agree to fix it as certainly not
lower than one-fourth, probably as high as one-half, possibly
as high even as three-fourths. '

Two weighty considerations have to be taken into account in
relation to this question : first, that the native infirmity or taint
may be small or great, showing itself in different degrees of
intensity, so as on the one hand to take efiect only when con-
spiring with more or less powerfjil exciting causes, or on the
other hand to give rise to insanity even amidst the most favour-
able external circumstances ; and, secondly, that *iioi mentar
derangement only in the parents, but other forms of nervous
disease in them, such as epilepsy, paroxysmal neuralgia, strong
hysteria, dipsomania, spasmodic asthma, hypochondriasis, and
that outcome of a sensitive and feeble nervous system, suicide,
may predispose to mental derangement in the offspring, as,
conversely, insanity in the parent may predispose to other forms
of nervous disease in the offspring. XVe properly distinguish
in our nomenclature the different nervous diseases which are
met with in practice according to the broad outlines of their
symptoms, but it frequently happens that they blend, combine,
or replace one another in a way that confounds our distinctions,
giving rise to hybrid varieties intermediate between those which
are regarded as typical.

This mingling and transformation of neuroses, which is ob-
served sometimes in the individual, is more "pMiiVj tcl^\!C^^j^\»

108 PATHOLOGY OF MIND. [cuap.

when the history of the course of nervous disease is traced
through generations ; if instead of limiting attention to the
individual we go on to scan and track the organic evolution
and decay of a family — ^processes which are sometimes going
on simultaneously in difiFerent members of it, one displaying
the outcome of its morbid, another of its progressive tendencies
— it is seen how close ai*e the fundamental relations of certain
nervous diseases and how artificial the distinctions between
them sometimes appear. Epilepsy in the parent comes out
perhaps as some form of insanity in the offspring, or insanity
in the parent as epilepsy in the child. Estimating i*oughly the
probable breeding results of a numTDcr of epileptic parents,
one might say that they would be very likely to lose many
children at an early age; that the chances were great that
some children would be epileptic ; and that there was almost
as great a risk that some would become insane. Chorea or
other convulsions in the child may be the consequence of great
nervous excitability, natural or accidentally produced, in the
mother. In families where there is a strong predisposition to
insanity, one member shall sometimes suffer from one form of
nervous disease, and another from another form : one perhaps has
epilepsy, another is afflicted with a severe neuralgia or with
hysteria, a third may commit suicide, a fourth becomes mania-
'^cal or melancholic, and it might even happen sometimes that a
/ fifth evinced remarkable artistic talent. Neuralgic headaches
S or megrims, various spasmodic movements or tics, asthma and
^, allied spasmodic troubles of breathing will oftentimes be dis-
covered 1^0 own a neurotic inheritance or to found one. The
neurotic diathesis is fimdamental ; its outcomes are various, and
determined we know not how ; but they may, I think, be
either predominantly sensory, or motor, or trophic in character.

Were we only as exact as we could wish to be in our re-
searches we ought then, in studying hereditary action and its
issues, to mark the different roads. It is plain there may be
(a) Heredity of the same form — that is, when a person suffers
'/ from the same kind of mental derangement as a parent had
which he seldom does except in the cases of suicide and dipso-
^ mania; (6) Heredity of allied form, as when he suffers from

III.1 THE CAUSATION AND PREVENTION OF INSANITY. 109

another kind of mental derangement than that which his parent
had — ia maniacal, for example, when he or she was melan-
cholic ; and (c) Heredity with transformation of neurosis — when
the ancestral malady was not mental derangement of any
sort, but some other kind of nervous disease. \ Whatever the
exact number of cases of mental disorder in *^ich hereditary
predisposition of some degree or kind, derived from the preced-
ing or from a more remote generation, is positively ascertained,
it may be asserted broadly that in the majority there has been
a native instability or infirmity of nervous element in the in-
dividual whereby he has been unable to bear the too heavy
burden of his life, and has broken down in mind. Complex and
various as the constitutional idiosyncrasies of men notably are,
it is obvious that statistics can never yield exact and conclusive
information concerning the causation of insanity ; here, as in so
many other instances of their employment, their principal value
is that they make known distinctly the existence of a certain
tendency, so to speak, which, once we have fairly grasped it,
furnishes a good starting-point for further and more rigorous
jesearches : they indicate the direction which a more exact
method of inquiry should take.

It will not be amiss to take note here that the filiation of
nervous disease is displayed more plainly in the so called
functional disorders, in which we are not able to detect any
morbid change of structure after death, than in the so called
organic diseases, in which there is visible deterioration of
structure. The reason probably is this: functional diseases
mark an intrinsic disorder of nerve element itself, of ultramicro-
scopical delicacy — ^intranervine so to speak — while the gross
destruction of nerve-structure which we observe in organic
disease is usually a secondary effect, extranervine, the primary
disease having originated in the walls of the blood-vessels or in
the elements of the connective tissua For example; when an extra-
vasation of blood breaks down the nerve structure in the neigh-
bourhood of the burst vessel, it is the degenerate artery which is
at fault ; and when a syphilitic or a cancerous tumour grows in
the brain to the detriment of the nervous structure on which it
encroaches steadily, it has had its origin not ia tk^ \>l^\n<^

110 PATHOLOGY OF MIND. [chap.

element, but in the perivascular spaces or in the elements of the
connective tissue. In both cases we have to do with a disease of
nutrition rather than with an essential disease of nerve element.
Tiie mental and nervous symptoms which occur are incidental
to the progress of the disease, not of its essence, being due
either to the direct destruction, or to the irritation, direct
or reflex, of nerve structure by the extravasated blood or the
morbid growth ; and hereditary action, if it showed itself at
all, might be expected to show itself in degenerate blood-
vessels or in similar morbid growths in the brain or elsewhere
in the body.

Nevertheless it must have chanced to every physician who
has had much to do with nervous diseases to have seen cases in
which a parental apoplexy has seemed to have distinctly pre-
disposed to insanity in the offspring. I call to mind an instance
in which four grown up members of a family of ten children
are already insane, and more will probably become so. I know
nothing more of their hereditary antecedents than that neither
father nor mother was insane ; both were extremely energetic
and industrious, and they built up from the humblest beginnings'
by their joint exertions a large and lucrative business in London.
The mother was of an anxious, inconstant, impatient, and some-
\^ what irritable temperament, always actively employed and an
^*!ite.ger woman of business, and she died at a good age. The
father, who was of a sanguine, choleric, and active temperament,
died two years after her from apoplexy, having had a previous
attack from which he had recovered. Though warned very gravely
after the first attack to be careful and temperate in work and in
habits, he paid not the least regard to the admonition, but was
eagerly employed in extending his business to the moment
when he was struck down by the fatal attack. In this case
the apoplectic catastrophe was plainly not the beginning of the
line of pathological degeneracy ; account ought to be taken of
the neurotic temperament which went before it, the eager, con-
tinued, and somewhat turbulent function of which, involving a
full and brisk determination of blood to the brain, might well
produce a too great and unintermitting strain upon the walls of
the bloodvessels, and so occasion degeneration of theii* structure ;

HI.] THE CAUSATION AND PREVENTION OF INSANITY. Ill

wherefore it was not the actual bursting of the weakened
vessel, but the antecedent conditions of nerve element, which
should be accounted the true predisposing cause. This has
been the real order of events, I believe, in other cases in which
apoplexy has appeared to predispose to insanity : in one genera-
tion might be noted irritability, a tendency to cerebral conges-
tion, with passionate and violent outbreaks, ending perhaps in
an apoplectic stroke; in the next generation a tendency to
cerebral haemorrhage, and the appearance of such neuroses as
epilepsy, suicidal disposition, and some form or other of mental
derangement.

There is reason to think that an innate taint or infirmity
of nerve-element may modify the manner in which other
diseases commonly manifest themselves ; for example, where it
exists, gout flying about the body will occasion obscure nervous
symptoms which puzzle the inexperienced practitioner, and it
wiU sometimes issue in a downright attack of insanity, instead
of showing itself by its ordinary inflammations. On the other
hand, there is no doubt that a parental disease which does not
affect specially the nervous system may notwithstanding be at
the foundation of a delicate nervous constitution in the off-
spring: scrofula, phthisis, syphilis perhaps, gout and diabetes
appear sometimes to play this part. On going through an idiot
asylum the appearance of scrofula among its inmates is suffi-
ciently striking; perhaps two-thirds, or even more, of all idiots
are of the scrofulous constitution.^ Lugol, who wiote a treatise
on scrofula, professes to have found insanity by no means un-
common amongst the parents of scrofulous and tuberculous
persons, and in one chapter he treats of hereditary scrofula
from paralytic, epileptic, and insane parents. In estimating the
value of observations of this kind, however, we may easily be
deceived unless we are careful to reflect that, independently of
any special relation between the two diseases, the enfeebled
nutrition of scrofula would be likely to light up any latent pre-
disposition to insanity which there might be, and so might seem
to have originated it when it was only a contributory factor,
and, on the othet hand, that insanity, and especially those

1 On Idiocy and Imbecility, By William W. Ireland. Wl^ , ^, 'L^t,
6

t

PATUOLOUY OF MIND. [(

forms of it in which Dutrition was much affbcted, would fester
the development of a. predispOBition to scrofula or phthisis.

Several writera on insanity have taken notice of a connection
between it and phthisis which they have thought to be more
than accidental. Schroeder van der Kolk was confident that
a hereditary predisposition to phthisis might predispose to or
develop into insanity, and, on the other hand, that insanity pre-
disposed to phthisis. With phthisis, however, there commonly
goes, as is well-known, a particularly eager, intense, impulsive,
and sanguine temperament, which may breed a more insanely
disposed temperament in the offspring, apart from any influence
■which the actual tubercular tendency may be supposed to have
or to have not. I am the more apt to think this the explanation,
because there is a third-rate artistic or poetic temperament,
altogether wanting in sobriety, breadth, and repose, and mani-
festing itself in intense but narrow idealisms, of an extrava-
gant or even grotesque character sometimes, or in caterwauling
shrieks of emotional spasm, put forth as poetry, which closely
resembles the phthisical temperament, and which is very likely
to breed insanity. There is no question in my mind that
insanity and phthisis are often met with as concomitant or
sequent effects in the course of family decadence, whether they
predispose to one another or not ; they are two diseases through
■which a family stock that is undergoing degeneracy gradually
becomes extinct, especially in those cases where the degeneracy
is the outcome of breeding in and in until all variety and vigour
have been bred out of the stock. When we are searching for the
predisposing conditions of a morbid neurosis in a particular
case, and fail to discover any history of antecedent insanity or
epilepsy, we shall do well then to inquire whether phthisis is a
femily disease. It is alleged that as many aa two-thii-ds of all
idiots die of phthisis. According to Dr. Clouston's observations,
made at the Morningside Asylum, tubercular deposit is twice as
frequent in the bodies of those who die insane as it is in the
bodies of those who die sane, and he professes to have found a
distinctly greater frequency of hereditary predisposition to in-
sanity among the tubercular than among tlie non- tubercular
^fJeuta. There is uot, I think, sufficient reason to suppose that

lor It
^■«f me

I;] TQE CAUSATION AND PREVENTION OF INSANITY. US. |

the remarkable remission of the syiuptoms of insanity which un-
doubtedly takea place often during the exacerbation of phtbiaia
in a patient who baa the two diseaaea, with the active recur-
rence of the mental aymptoma when the aigna of phthisical
activity abate, tesLiBea to any apecial connection between them ;
for it appears to be no more tlian an instance of such abatement

hof mental aymptoms as is observed when other acute disease
in an insane patient.
Diabetes is a diseaau which often shows itself in families in
which insanity prevails : whether the one disease predisposes
in any way to the other or not, or whether they are independent
outcomes of a common neurosis, they are certainly found to run
aide by side, or alternately with one another, more often tliau
can be accounted for by accidental coincidence or sequence.
For the present I am content to note the fact that the children
of a diabetic parent sometimes manifest neurotic peculiarities,
without devising an explanation which must be hypotheticaL
This we know: that diabetes is sometimes caused in man by
meutal an:dety; that it is produced artificially in animals by
irritation of the fourth ventricle and some adjacent parts of the
brain ; and that a great many diabetic patients die of phthisis.
Perhaps I might set it down as a true generalization that the
morbid neurosia, when it is active and gets distinct morbid
expression, may manifest itself in four ways — (a) in disorder of
sensation — for example, paroxysmal neuralgia; (b) in disorder
of motion — for example, epilepsy ; (c) in disorder of thought
feeling, and will — mental derangement ; (d) in disorder of

■nutrition, whereof diabetes is the earlier and phtbiaia the later

The late M. Morel of Rouen prosecuted some original and in— I
Btmctive researches into the formation of degenerate or morbid
varieties of the human kind, showing the steps of the descent
by which degeneracy increases through generations, and issnes
finally, if unchecked by counteracting influences, in the extinc-
tion of the family. When some of the unfavourable conditions
of life which are believed to originate disease — such as the
air of a marshy district, the unknown endemic causes
■tinism, the overcrowding and starvation ol Xm^^ "iiNis

Ki .autril
^K Th'

1

^^ptU PATHOLOGY OF MIND. [ctui^H

continued intemperance or excesses of any kind, frequent inter-
marriaf^a in families — Lave engendered a morbid variety, it ia
the beginning of a calamity which may gather force through
geueratious, until the degeneration has gone so far that the con-
tinuation of the species aioug that line ia impossible. Insanity,
of what form soever, whether mania, melancholia, moral in-

»Banity, dementia, may be looked upon then philosophically as
& stage in the descent towards sterile idiocy ; as might be proved
experimentally by the intermarriage of insane persons for two
or three generations, and aa is proved undesignedly sometimes
by the disastrous couaequencea of frequent intermarriages in
foolish families. The history of one family which Morel in-
vestigated with gi'eat care may be quoted aa an extreme
example of the natural course of degeneration when it goes on
unchecked through generations. Were it an invention only,
it would he one of thoae inventions that teach excellent trutli.
It may be summed up thus : —
First Gmeration. — Immorality, depravity, alcoholic excesses,

• and great moral degradation in great-grandfather, who was
killed in a tavern brawl.
Second Generation. — Hereditary drunkenness, maniacal attacks
ending in general paralysis in the grandfather.

Third Generation. — Sobriety, but hypochondriacal tendencies,
delusions of persecution, and homicidal tendencies in the
father.

Fourth Generation. — Defective intelligence. First attack of
mania at sixteen yeara of age ; stupidity and transition to com-
plete idiocy. Probable extinction of the morbid line; for the
generative functions were as little developed as those of a child
of twelve years of age. He had two sisters, who were both

■ defective physically and morally, and were classed aa imbeciles.
To make the proof of morbid heredity more striking, it may be
added that the mother had an adulterous child while the father
was confined in the asylum, and that this child did not exhibit
any signs of degeneracy.

In this history of a family we have an instructive example

of a retrograde movement of the human kind, ending in so wide

deviation from the normal type that sterQity ensues ; it is the

I

ra.] THE CAUSATION AND PKEVENTION OF INSANITY. 116

opposite of that movement of progressive specialization and
increasing complexity of relation with the external which mark
advancing development. All the moral and intellectual acqui-
sitions of culture which the race has been slowly putting on by
organized inheritance of the accumulated experience of count-
less generations of men are rapidly put off in a few generations,
until the lowest human and fundamental animal elements only
are left in an abortive state : in place of sound and proper
social elements which may take their part and discharge their
function harmoniously in the social organism we have morbid
elements fit only for excretion from it The comparison of the
social fabric with the bodily organism is well founded and in-
structive. As in bodily disease there is a retrograde meta-
morphosis of formative action whereby morbid elements are
produced which cannot minister to healthy function, but will, if
not got rid of, occasion disorder or death ; so in the social fabric
there is likewise a retrograde metamorphosis whereby morbid
varieties or degenerations of the human kind are produced,
which, being antisocial, will, if not rendered innocuous by
sequestration in it, or if not extruded violently from it, give
rise to disorder incompatible with its stability. How exactly
do the results of degeneracy accord with what was said concern-
ing the aim of human progress and the fundamental meaning
of insanity!

Let it be noted that however much man may degenerate
from his high estate he never actually reverts to the exact
type of the animal, though he may sink in idiocy to a lower
stage of degradation than it; when he has been stripped of
all his essential human qualities and degraded almost to his
bare animal instincts, he certainly presents an animal like-
ness which may justify the description of his condition as a
iheroid degeneracy ; but he is unlike in these respects — first, that
his mental wreck yields evidence of the height from which he
has fallen, and, secondly, that the fundamental instincts want
the vigour and wholesome activity of the animal, or are actually
debased. The latter can, by virtue of its healthy instincts,
adjust itself successfully to its surroundings and flourish; he,
unable to do so by reason of the debasement oi \i\a m^'Cvc^O^ ^'t^

I

I

PATUOLOGY OF MIND. [cn^

of their unfitness to cope witli the complexity of Iiis surround-
ings, would perish soon but for tiie helpful care of his kind.

In the lowest forms of insanity and idiocy there are sometimes
exhibited remarkable &nima1-like instincts and traits of cha-
racter, which may even go along with corresponding conforma-
tion of body : witness the stories told^I know not how truly —
of idiot mothers who, after delivery, have guawed through the
umbilical cord; the idiot described by Pinel, who was much
like a sheep in appearance, in habits, and in hia cry ; the idiot
described by Dr. Mitchell, who presented a singular resemblance
to a monkey in liia features, in the conformation of his body, and
in his habits ; the habit of iiimination of food which has been
observed in some insane persons and idiots, and the savage fury
and the bestialities exhibited by others : — all these testify to
the brute brain within the man's, and may be looked upon as
instances of partial reversion, proofs that the animal has not
yet completely died out of him, faint echoea from a far distant
past testifying to a kinship which he has almost outgrown. It
may be thought a wild notion that man should even now dis-
play traees of his primeval kinship when countless ages have
confessedly elapsed since he started on the track of his special
development, hut a little consideration will take from the
strangeness of it. In the first place, long way as he is from
the animals, he still passes in the course of his embryonic de-
velopment through successive stages at which he resembles not
» little the permanent conditions of certain classes of them ; he
may be said, in fact, to represent in succession a fiah, a bird, a
quadruped in his course before he becomes human ; and these
transitional phases are preaiimahly to he interpreted as the
abstract and brief chronicle of the successive throes or stages
of evolution through which nature went before man was brought
forth. "Whether that be so or not, the metamorphoses are proofs
at any rate that the I'oundations of hia being are laid upon
the same lines as those of the vertebrate animals, and that lie
has deep within him common qualities of nature which, when
the higher qualities of his special nature are gone, will manifest
themselves in animal-like traits of character. In the second
piaee. Jet nnj one consider curiously the fundamental instincts

P^pC] THE CAUSATION AND PREVENTION OF INSANITY. Ul^H

^PS<

of self-conservation and propagation, resolutflly laying bare their
roots, taking note of their intimations in children long before
their meaning is understood by them, and giving attention to their
manifestations among all sorts and conditions of men, sav^e and
civilised, he will not fail to perceive and confess how thoroughly
animal is man at bottom. He will apprehend this the more clearly
if he goes on to trace, as he may, the development of many
' the highest qualities of human intelligence and feeling from

leir roots in these fundamental instincts. Our sympathies with
other living things, our interests ia their sufferings and doings
our success in understanding them and making ourselves undaM^
stood by them, our power to train and use them fur our servicei^^
would he impossible hut for a common foundation of nature.

It has been a question whether a father or a mother was more
likely to transmit an insane bias to the children. Esquirol
found that it descended more often from the mother tlian from
the father, and from the mother to the daughters more often
than to the sons ; and to this opinion Baillarger subscribes.
From an elaborate report to the French Government by M.
M^hia it would seem that it is most likely to pass fronf
father to son and from mother to daughter ;/for out of 1,000 ■
admissions of each sex into French asylums bp found that 264
males and 2(36 females had suffered from hereditary predisjw-
sition ; that of the 2G4 males 128 had inherited the 4'sease
from their fathers, 110 from their mothers, and 26 froili both
parents ; and that of the 266 females, 100 had inlierij^d from
father, 130 from mothers, and 36 from both parents. / It might
be qnestioned whether the sex of the parent in itself has much
directly to do with determining the line of descent to son or
daughter ; it is not perhaps that the male inherits preferenti-
ally from the male, and the female from the female, by virtue of
eex, but that there is more insanity inherited from one or the •
other accoi'ding as there are more male or female children among
the offspring. If male children have preponderated in the
family of the father who transmits the insanity to his children,
nnd if he displays in marriage that superior potency in propa-
.eation by which his family tendency obtains and male children

fponderate among his offspring, there will moat llkftl-j \ift"GiK!»^

I

I

PATUOLOGY OF lUKD. [l

of insanity descending frum father to son, tut if female
children preponderate among bis oflspring, it is probable that
there will be a stronger stream of descent from father to daughter
To get at real information we should have to go deeper and to
discover the unknown causes which determine sex. It is hard
to undei-stand that a daughter who resembles an insane father in
her whole temperament of body and mind more than a son does
should be less likely than the son to inherit a morbid trtint of
character from him, Mr. fialton's ' first inquiries concerning
hereditary genius led him to the conclusion that, contrary to
common opinion, the female influence was inferior to the male
in transmitting ability, but when he came to revise hia data
more closely, he saw reason to conclude that the influence of
females is but little inferior to that of males in such trausmis-
aion. It may be said with ec^ual truth probably both of ability
and insanity that while transmission to the same sex and trans-
mission to the other sex are common enough, the relative
frequency of their occurrence is yet uncertain.

Some writers subscribe to the plausible theory which has come
down from antiquity, that madness, like other hereditary diseases,
is most likely to be transmitted to the child which resembles
most in features and disposition the insane parent, and that a
person who has the misfortune to be so descended may therefore
take comfort to himself if he is unlike that parent. However,
the conclusion must not be made absolute ; it does not follow
that a child who resembles a parent in features shall have a
aimilar disposition, since there is assuredly no constant relation
between resemblance of features and of moral disposition ; and
of course it is not where the bodily features are alike, hut where
tiie mental disposition is of the same kind, that we should expect
to observe such operation of the law of heredity. I have noticed
too in some cases that a likeness to one parent or to his or her
family type which comes out strongly at one period of life may
wane gradually and be replaced by a greater likeness to the other
parent or to his or her family type at a later period of life ; the
son who calls to mind his mother at twenty years old perhaps
calls his father to mind at forty ; and the daughter who wua

■°^

'■ Ileretl. Gen. p. G3. ^mM

ni.] THE CAUSATION AND PREVENTION OF INSANITY. 119

like her father at twenty puts on more of her mother's simili-
tude at forty. It is plain then that a son or a daughter who had
been unlike the insane parent might as time went on take up
with the family resemblance a tendency to the parental disease.^
In any case there is no doubt that a child born after an
outbreak of parental insanity is more likely to suffer from
insanity than one that was born before the outbreak.

In considering the period of life at which a hereditary predis-
position to insanity or any other such predisposition wiU sho w
itself in actual disease, it should be borne in mind that certain
organs or systems of organs are particularly active at certain
ages, when they will naturally be more prone to fall into that
disordered action to which they are intrinsically disposed. In
like manner they may be less predisposed to one and more pre-
disposed to another kind of morbid action when their decay and
the decline of their functions begin in old age. In infancy, as
Petit has pointed out, the lymphatic and the nervous systems
predominate, for which reason scrofula and epilepsy are the
hereditary diseases which then most show themselves. As
years go on the muscular system undergoes great development,
the sexual organs begin their function, and the whole vascular
system is very active ; wherefore inflammatory diseases are most
apt to occur, pulmonary diseases to accompany or to follow
the development of the chest, and nervous derangements of a
hysterical or allied nature to attest the revolution which
the development of the sexual organs produces in the entire
economy. Before puberty nature's chief concern has been with
physical development ; but with the new desires and impulses
which spring up after puberty,- when the individual life begins
to expand into social life, the mind undergoes a transformation,

^ A man may get great help in self-knowledge sometimes by observing
and reflecting on the characters of the different members of his family —
father, mother, uncles, brothers, sisters, &c., for he may see in them the
developed outcomes of hidden tendencies in himself, the written-out expo-
sition, as it were, of what is understood in him. When he cannot under-
stand why he should have acted in a certain way on a particular occasion,
a trait in his brother's or his child's character may furnish the explanation.
Note in this relation how the same face in different aspects and expres-
sions suggests the features of different members of the family, and ko^ ti\ftk
dead person's face sometimes shows a likeness Beaxe^X^ '^etCiW^^ VcL\&a,

I

I

120 PATHOLOGY OF MrXD, TcBuCI

and tlie consequence is that Iiereditary insanity may declare
itself; if not directly after puberty as tlic result of the natural
physiological action becomitig pathological, still in the years
tliat immediately follow it, when the miud is moat tried, being
under a strain of energy in the novel adjustment to the condi-
tions of active life, or when overworked in the subsequent years
of eager competition during manhood. Many men break down
too in these years from the enervating effects of sexual excesses
vpon an excitable and feeble nervous system, and of course
women may break down under the trials of pregnancy and par-
turition. In later manhood rheumatism and gout attest, the former
perhaps a muscular system which, having reached the prime of
its energy, now discovers a strain of weakness or begins to
decline ; the latter, a decay of the powers of assimilation and
nutrition which is not acknowledged prudently by giving them
less to do. At a more advanced age still the abdomen seems to
take up the tale : the energy of feeling and desire, which haa its
physiological source in the visceral organs and inspires vigorous
self-assertion and practical will, abates gradually as they become
dull and weary; the result being a tendency to sombre and
gloomy feelings which may pass into hypochondria aud melan-
cholia. Lastly in old age the tissues degenerate and the cerebral
vessels give way in apoplexy ; or the brain shrinks in decay and
senile dementia ensues.

Consanyuineoua Marringrs. — Wliether these marriages breed
degenerate offspring is a question which has been much dis-
puted, some writers having impugned the general opinion that
their effects are bad. It is a subject concerning which it is
difficult to make exact inquiries, and impossible to arrive at
trustworthy results ; and Mr. G. Darwin, who undertook a series
of painstaking inquiries lately, was obliged to abandon them
without having reached conclusions wliich he could put forward
with any confidence ; so far as they went, however, his inquiries
fieemed to show that there was not good reason to declare that
.'Buch marriages had any ill effect.* Inasmuch as the wisdom of
inankind is greater than the wisdom of any individual in any
matter of common experience, where no special means ofn
' Jtivmal of StatUlical Socifly, June 1875.

I

K

^

^^H)]

In.] THE CAUSATION AND PREVENTION OF INSANITY.

ibaervKtion have been used, because the area Uiereof is so much
iater, the numerous spritiga which feed it liowiiig into the
iRimon receptacle I'rom all quarters and iii all ages, I caunot
Tielp thinking that we ought justly to attach great weight to the
prohibitioua of intermarriagea of neiir of kin which have been
made by all sorts of peoples in all times and places : they are
apparently an argument of the universal belief of their ill
effects. Amongst the lower races the range of prohibition is
much greater thau in the civilised world, extending to the most
distant relatives by blood. Certainly the popular conviction
nowadays is that such intermarriages are more prone than not-
akiu marriages to breed idiocy, insanity, and deaf-mutism. Who-
soever wishes to test the opinion with animals let him try
experiments with a select breed of pigs, breeding in and in for
several generations, and never crossing them with any strain
from without, and he will find in fuU time, if his experiments
coincide with mine accidentally made once, that his sows have
no young or only two or three at a Utter, and that they are
very likely to savagely worry those which they have : that he
must, if he would go on keeping pigs, cross or change his breed.
Tor the last dozen years or so a record has been kept of the
number of mares among racers which have proved barren or
have prematurely slipped their foals ; and it deserves notice,
Mr. Darwin says, as showing how infertile tlieae higiily nurtured

ind closely interbred animals have become, that not far from
le third of the mares fail to produce living foala.
The main or oidy argument wliich those who reject the
ipular belief put forward is to point to some remarkable in-
stances, such as tlie celebrated racehorse Eclipse, of the higher
qualities of the kind in the products of close interbreeding.
Granting the special qualities developed in these cases to be of
as high a natnre as they are assumed to he, all that the ex-
amples really prove is that sometimes interbreeding has no bad
effect; they prove nothing with, regard to the question whether
the genei-al results of interbreeding are not bad. T!ie lesson
which we ought to learn from them is to go beneath the general
fact of interbreeding, and to search for those more intimate

^^Kfmd special conditions which detentiine good results, to w. ^SiM|^|

^^hS-- PATHOLOGY OF MIND. [coAK^H

instances, and bad results in many other instances ; not to stay
satisfied with the bare experience of interbreeding, but to dis-
cover the ill conditions wliiuh, sometimes failing, commonly
accompany it. _^H

A theory that has been propounded to explain the differeq^^^^
effects of interbreeding is that when there is any strain of weafe>^^H
nes8 in the family, such as madness, or deafness, or consumption,'
it intensifies the bad elements, and so causes disastrous results ;
wherefore when the sesual elements wiiich combine are per-
fectly sound and stable no ill consequences ensue, Mr, Darwiu's
recent patient and careful inquiries into the effects of cross and
self-fertilization in the vegetable kingdom are most instructive
in this relation. They have shown that plants gain distinct
advantages from cross -fertilization in larger and better growth,
in increased capacity to resist adverse external circumstances,
and in increased fertility ; and that the introduction of a fresh
stock to remedy the evils of interbreeding is as marked in
plants as it has long been known by breuders to be in animals.
He has come to the conclusion that the advantages of cross-
fertilization are the result, not of any myst«rious virtue in the
union of distinct individuals, but of the different conditions
to which the individuals have been subjected during pre-
vious generations, and to the differentiations which have been
thereby produced in them ; for he has noticed that cross-fertili-
zation by plants that have been in similar external conditions
is not beneficial. From want of such differentiations he believes
it is that self-fertilization works injuriously. Applying this
doctrine to tho interbreeding of animals we shall conclude
that the bane of near-akin intermarriages springs — first, from the
persons having inherited similar peculiarities of nature, and,
secondly, from their having been brought up in similar external
conditions, whereby the peculiarities have been fostered and no
variation has been elicited. This being so, it is plain that the
results need nob always be bad ; if there are innate essential
differences between cousins, or if, not being much different
essentially, they have been bred and reared in very different
^^ conditions, there will be such wholesome differentiations of
^L natures as to obviate any tendency to the exaggeration of^^fl

r

THE CAUSATION AND PREVENTION OF INSANITY. 123 I

peculiarities by intermarriage, and the results msiy be excellent.
Breeders are accnstomed to separate male and female animals
of the same offspring early in life, and to put them in
widely different conditions, when they intend them to inter-
breed; then they get good results. This agrees with the
aphorism of Hippocrates, that we ought to change the constitu-
tions of individuals in order to prevent the diseases to which
they are hereditarily predisposed, which is to be done, he
says, by placing them in difl'erent circumstances from those
by which their parenta were surrounded.

It will not be amiss to bear in mind, when drawing con-
clusions from observation of the results of animal interbreeding,
that the bi'eeder's object often is to exaggerate and fix a parti- .
cular variation or peculiarity of the animal which is advanta-
geous not to it, but to him, or only to it through him, not to
breed the completest animal of its kind, or to cultivate a varia-
tion which might suit the auimal best ; a racehorse is not fit for
much else besides racing, nor a certain breed of sheep fit for
much else except to get fat upon turnips. We cannot apply that
principle incontinently to human beings, in whom on the whole
it would seem best not to exaggerate a particular quality, but
to breed as complete a nature as possible, a being capable of ^^
fair development all round. ^^H

Another caution may fitly be suggested — namely, to take ^^M
heed not to over-estimate the range of the limited differentia- ^^H
tions which different conditions of life can produce, within the '

terms of their lives, in two persons of the same family whose
natures ai-e alike fundamentally ; for development can only pro-
ceed upon the lines laid in the nature, following its radical
tendencies, and all variations which different external con-
ditions ean produce will be superficial and transitory, having ^^
small influence in interbreeding compared with the deep and ^^M
permanent sameness of nature. Try as hard as one can to ^^|
quell nature, one cannot quench it ; it will come out in the ^H
critical momenta of life, and wOl show itself in hereditary
transmission. It is possible that a man may resemble his aunt
more than his father or mother, and that his female cousin, |

^^l^liose mother the aunt is, may be vei-y like her moX\v«t ■, ft.w&. ^^i^^|

PATHOLOGY OF MIND. [coAr.

^^B they two many, the result might conceivably be as bad as if
^^M brother and sister married ; hut if the two were as unlike as
^^m two persons wlio were not in the least akin to one another, by
^H reason of their representing different lines of the ancestral
^^K pedigree, then there might be little or no risk. Even in that
^^P case, however, it is proper to remember what has been said con-
cerning the latency of qualities in the individual of one genera-
tion which may nevertheless blossom in his offspring ; and the
k possibility that the union of two imlike cousins might chance to
issue in the development of some of these latent like qualities.
Prudence would dictate the avoidance of intermarriages of near-
a-kin in all cases, and particularly so in those cases in which
there is not distinct evidence of radical differences so great as
those which there are between persons not in the least related
to one another.
This theory of the mode of operation of interbreeding agrees
with what was previously said concerning the sexual union of
unanitable natures who were not related to one another by
kinship. When two persons of mean, suspicious, aud distnist-
ful character mairy they are likely to intensify the antisocial
peculiarity, which may culminate in such a want of balance in

>the ofi'spring that he cannot mix at all with his kind, is a com-
plete discord in nature. In like manner when marriage takes
place between two persons of an intense but narrow artistic or
poetic temperament, whose thiu idealistic aspirations, miscaUed
great imagination, are not informed by that sincere and whole-
some converse with realities which lays up a capital of sober
sense — in whose minds the emotional element has, so to speak,
run to seed — tliey are likely enough to breed an unstable pro-
duct, which may be looked upon as a pathological evolution of
B their natures. The further misfortune is that the- natural
tendency to an intensification of the neurotic type, declaring
itself by a sympathy of feelings, tastes, and pursuits, draws such
persons to cultivate each other's society and so to fall in love
and marry. Or if a person of this temperament should marry
a woman of sounder and more sober temperament who takes a
^^ wholesome view of the exigencies and enjoyments of life, his
^K narrow self-feeling will be much hurt, be will wail at what be

THE CAUSATION AND PREVENTION OF INSANITY.

^

enan

Buffers from want of sympathy and of appreciation, and -will
perhaps separate from liis wife on the ground of incompatibility.
Then again these persons choose by a natural affinity those
external circumstances of life which are suited to foster rather
than to check the special tendencies of their natures, not
enduring repugnant circumstances and getting the benefit of
iliem in wholesome discipline and self-culture, as a sounder and
ir nature would ; they solicit not differentiations but in-
lify peculiarities of nature until these become pathological.
They do consciously, in fact, what ia done blindly when family
peculiarities are intenaified by intermarriages of near of kin.
Lastly, they mismanage their children aa they mismanage them-
selves, training them, wittingly or unwittingly, along the lines
of their abnormal tendencies. No wonder, after such prepara-
tion and training, that a being is developed eventually of so
irregular and unstable a nature'that he is practically a morbid
element and can take no part in the functions of the social
organism.

Tliose who have made a study of the causes of deaf-mutism
are satisfied of the ill effects of blood-kinship of parents. Some
affirm that there. are more eases of congenital deafness from
the marriage of first cou.?in3 than fiwm all other causes put
together; while others think congenital deafness in one or
both parents a more fmitful source of congenital deafness than
any other. Certain it is that it is a common thing, when
enquiring about the relatives of pupils in the different institu-
tions for the deaf and dumb, to hear that a parent, or an uncle,
or an annt, or a cousin was congenitally deaf. It is obviously
in those cases in which there is a tendency to deafness in the
family that the maniage of first cousins will be most in-
jurious, because it will be likely to intensify the defect, but
why such intermarriage by itself, when there was no tendency
to deafness in the family, should occasion it, we know not any
more than we know in the least why blue-eyed cats shoidd be
deaf. There are correlations of oi^anic structure and function,
physiological and pathological, which we must be content to

I observe and note for the present without beiii^ aVile to give the ^^-
\eaat explanation of tbrm. Ueaf persona uvu \>YOT\ft Vo -cwsrc^^H

1:46 PATHOLOGY OF MIND. [ch. m.

those who are similarly afflicted ; being unable to mix com-
fortably with persons who can hear, they are drawn to others
like themselves with whom they can converse on equal terms,
and so intermarry, propinquity and sympathy breeding love, and
transmit the evil from generation to generation. The advocates
of the "German" system of teaching and training the deaf
and dumb — the system which is based upon articulation and
lip reading — claim one advantage of it to be that it tends
to prevent such intermarriages, as it enables the deaf to ap-
prehend what is said by perception of the movements of the
lips, and so to mix better with their fellow-creatures. In like
manner, it is a right training to remove a person of an in-
sane temperament from habitual intercourse with a person of a
similar temperament, and to subject him to quite other external
influences, inasmuch as the change is fitted, by fostering
variations of character, to produce a more stable nature, and, by
widening his circle of social intercourse, to lessen the proba-
bility of marriage with a similarly constituted person.

With these remarks concerning consanguineous maiTiages I
pass from the consideration of the antecedent conditions which
lay the foundation of a predisposition to insanity in the indi-
vidual, and go on to consider the conditions of life which
favour its development. One may take it to be broadly true
that the circumstances which augment a predisposition to in-
sanity, so that the disease ultimately breaks out, are just the
circumstances which are calculated to generate it de novo —
namely, all those things which help to put an individual out
of healthy relations with his social and physical surroundings.

CHAPTER IV.

THE CAUSATION AND PBEVENTION OF INSANITY {continued).

Conditions of Life. — In dealiog with the subjects which may
be brought under this comprehensive heading it will be necessary
to be as bri<xf and concise as is consistent with clearness.

A question has been much discussed, and is not yet settled
satisfactorily, whether insanity has increased with the progress
of civilisation and is still increasing in the community out
of proportion to the increase of the population. Travellers
are agreed that it is a disease which they seldom meet with
amongst barbarous peoples. But that is no proof that it does
not occur. Among savages those who are weak in body or
in mind, the sick and the helpless, who would be a burden
to the community, are often eliminated, being either killed
or driven into the bush and left to perish there ; certainly the
weak units are not carefully tended, as they are among civilised
nations. In this way not only is the amount of existing insanity
rendered small, but its propagation to the next generation is
prevented. Admitting the comparative immunity of uncivilised
peoples from insanity, it is not difficult to conceive reasons for it.
On looking at any table which sets forth the usual causes of the
disease, we find that hereditary predisposition, intemperance,
and mental anxieties of some kind or other cover nearly the
whole field of causation. From these three great classes of
causes savages are nearly exempt. They do not intermarry,
the prohibition of marriage extending among them to distant
blood-relations, and, as I have just pointed out, they do not
mucli propagate the disease from one genexaXivon \iCi ^xvs>?Ow£^^

I

PATHOLOGY OF MIND. [cbap,

because it ia got rid of to a great extent among them by natural
or artificial means of elimiaation. Secondly, ■ they do not
poison their brains with alcohol, at any rate not until the
white man brings it to them; when they do obtain it. they no
doubt abandon themselves to great debauches, but they cannot
obtain the regular supply wliich would enable them to keep
their brains day after day in a state of artificial excitement ;
and it may fairly be questioned whether alcohol, however and
in whatever quantities it may be taken, is so likely to produce
mental derangement in the undeveloped brain of a savage,
which has so little mental function to perform, as in the mora
complex and specialized structiire of a civilised brain.' Lastly,
the savage has few and simple wants springing from his appetites,
and theoi he gratifies : lie is free from the manifold artificial
passions and desires which go along with the multiplied indus-
tries, the eager competitions, the social ambitions of an active
civilisation ; he is free too from the conventional restraints upon
his natural passions which civilisation imposes, and sufl'crs not
from a conflict between urgent desire of gratiScation and the
duty to suppress all manifestations thereof, a conflict which
sometiines proves too great a strain upon the mind of a civilised
pereon.

On the other hand, it may be thought that the savage
must suffer ill consequences from tlie unrestrained indulgence of
his fierce sensual passions. But it might not be amiss to con-
sider curiously whether sav^e nudity provokes sensuality so
much as civilised dress, especially dress that ia artfully desi^^ed
to suggest what it conceals. There is no scope for the imagina-
tion where nothing is concealed and suggested, and it may be that
clothing is sometimes a stimulus to immodest thoughts, and that,
like the conventional covering of the passions, it inflames desire.
Be that as it may, the savage ia not disquieted by fretting social
passions : with him there is no eager straining beyond bis
strength after aims that are not intrinsically worth the labour

1 Cttmeroii, in his Journey acrote AJrka, saya tljat he met witli one man
_jly who waa Buffering from deliriutn tremonit ; it was tlie only inatance

of this difiorder which he saw in Africa, thougl] drunkenness mas cc

The supply of ponihS, the intoxicating liquor, often fulls short, beca
Sroni iv]iii;li they make it ia not abundaut.

%} THE CAUSATION AND PKEVESTION OF INSANITY. 129 ■]

and vexations which they cost, ao disappointed amliition from
failure to compass such aims, no gloomy dejection from the
reaction which follows the successful attainment of an over-
rated ambition, no pining regrets, no feverish envy of com-
petition, no anxious sense of responsibility, no heaven of
aspiration nor hell of fulfilled desire ; he has no life-long
bypociisiea to keep up, no gnawing remorse of conscience to
endure, no tormenting reflections of an exaggerated aelf-
coasciousness ; he has none, in fact, of the complex: passions
which make the chief wear and tear of civilised life. His
conscience is a very primitive affair, being no more than a
sense of right attaching to the beliefs and customs of his tribe,
hut snch as it 13 he seldom goes against it ; he may cheat, li^ '
steal, violate all the dictates of a true moral sense, especially 1
in his relations with the members of other tribes ; but he obeys '
bis tribal conscience, as the animal obeys its instinct, without
feeling a temptation to violate it. He is extraordinarily con-
servative, the custom of his fatbers being for him the fullest
justification of any belief or practice, however monstrous or
irksome ; he is free therefore from the perils which to unstable
natures lie in the excitement produced by revolutionary change
and in the adjustment to new relations exacted thereby. So it
comes to pass that he is not subject to the powerful moral
causes of mental derangement which act upon the civilised
person, and that he cannot suffer from some of the forms of
derangement which afllict the latter.

These considerations favour the accepted notion that insanity
is less common among uncivilised than among civibsed peoples,
and that there is an increased liability to mental disorder going
along with an increase in the complexity of the mental organiza-
tion. Certainly it is in accordance with common sense to
suppose that a complex machine, like the civibsed brain, which
is constructed of many special and delicate parts working
together in the most nicely adjusted relations, will be exposed
to moi-e risk of derangement of action and be more bkely to
go wrong than a simpler and coarser machine, the less various
parts of which have less fine and complicated relations. Aa
there is a greater liability to disease and U\e ^o?,?.\!ti\i:\\.-^

4

i

PATHOLOGY OF MIND. [CB^^I

many more diseases in a complex oi^aiiism like the human body,
where thei'e are many kinds of tissue, an orderly subordination
of parts, and a working of the whole in every part and of every
part in the whole, than in a simple organism where there is
little differentiation and less complexity of structure ; so in the
complex mental organization having the manifold special and
complex relations with the external which a state of civilisation
implies there are plainly the occasions of more easily produced
and more varied derangements than in the comparatively simple
mental oryanizntion of the savage. We might expect that
mental sufferings would be as tew and simple in an infantile
stage of society as they are in the infancy of the individual,
and the morbid outcomes of them as few and simple also.
The native Australian, who hns not in liia language any words
for vice and justice, nor in his life any tnie moral relations,
having no such ideas as the words express and no such senti-
ments as social relations stir in an ordinarily intelligent
European, cannot ever present an example of true moral
insanity ; before he can undergo such moral degeneration he
must first be humanized and then civilised ; mental organiza-
tion must precede mental disorganization.' That degenerate
nervous function in young children manifests itself in convul-
sions rather than in mental disorder; that the lower animals
Beldom suffer from mental disorder ; that it is of comparatively
rare occurrence among savages, and that it takes one of two
or three simple forms when it does occur among them — are
facts which are owing to one and the same cause, namely, a
want of development of the mental organization. As is the
height so is the depth, they are opposite and equal : with the
progi'ess of mankind to a higher stage of evolution there are cor-
relative possibilities of retrograde change ; the weaker members
who cannot bear the strain of progress will fall by the wayside ;
and an increased quantity aa well as an increased variety of

' A particular sense, it is true, may he more ncufe in a savafte than in
a civilised person, e.g. eight, hearing, or Bmell, tut ifi tlie case also in the
animal ; bnt neither in savage nor aniniBl has anj one oi these senseH ttia
delipate shadee and varieties o£ Busceplihilitj' which it has in the civilised
person, who may accordingly have TarietieH of Lallucinations of them,
when disorderedj which the savage cannot have.

w

THE CAUSATION AND PKEVENTION OF INSANITY. ISH

mental derangement will bear witness that the individual
perishes, while tlie race grows more and more.

ELsiiig some steps higher than savages to a people which,
having long ago reached a certain level of civilisation, has ever
since remained stationary at it, we find it stated that though
diseases of the nervous system are by no means uncommon
among the Cliinese, cases of mental alienation are comparatively
few — that is to say, if suicides are not counted as madness ;
for the Chinese will go to his death by suicide as quietly and
methodically as he would go to his bed.* Perhaps this in-
frecjuency of insanity is what might have been expected from
the natural character of the Chinaman, who is placid, steady,
equable, nowise disquieting himself about business, religion, or
politics, but doing his work in a calm methodical way, and
accepting good or ill fortune alike with equanimity. It must
be borne in mind, however, that lunatics are very harshly
treated in Ciiina, being usually tied up, sadly neglected, and
cruelly used by their friends and relations ; and this sort of
treatment cannot fail to lessen the number of existing casea,
apart from any question as to the number of occurring cases.

Alarming statements are often made concerning the rapid
increase of insanity which is supposed to be going on year by
year in civilised countries; and the figures which are quoted
certainly look formidable, In 1844 there were in England and
Wales 20,611 registered insane persons; in 1359 the number
had risen to 36,702; in 1869 it was 53,177; and on the 1st
January, 1878, it was 68,538. Or, calculating the proportion of
idiots and lunatics to the increasing population, it was, in 1859^
18G7 to 10,000; in 1869, 23-93; on the 1st January, 1878,
27'57-* The broad truth is that there is about one registered,
insane person to 365 of the popidatiou now, while the propor-
tion in 1859 was one in 540. The very greatness of this
increase, however, might well raise a suspicion that it has not
been due mainly to an increased production of insanity in the
population ; for whether the course of human events during the
last quarter of a century has been good or bad, it certainly has

I

' Journal of Mtnfal Smrece, 1B75, p. 31.
' Tkirty-Swond Beport of the Luitaqf Commi

J

CHij^^^

I

PATnOI-OGY OF MIN'a [<

not differed ao much from that of former times, or differed s
much aad bo Ciipriciously during the quarter of a century, as
such a difference in the quantity of Insanity, were it due to it,
would mean. Without douht the main part of this increase is
owing to the more stringent regulations which from time to time
have heen made and enforced for the registration and protection of
iusime peraona, whereby many tliat were never heard of oflicially
at one time are uow duly registered and counted. When the
admissions of each year into asylums are examined, which re-
present pretty fairly the numbers of occurring coses, it is observed
that a marked rise in the numbers has followed the enactment
of some new Act of Parliament, the direct effect of which has
been to force insane paupers into asylums : the increase has not
been steadily progressive, hut has taken place rather by leaps
and bounds which have answered the stimulus of each fresh
parliamentary enactment. It will be noted furthermore that
the increase is mainly among paupers, since the ratio of private
lunatics to the population (per 10,000) has been as follows : —

271

Thus there has been little change during the last five years — an
ncrease of only half a lunatic in 10,000 persons since 1859.

On examining the admissions of private patients each year
and calculating their ratio to the increasing population of the
country, it will be found that the fi,guTe3 do not point to a
steadily increased production of insanity in the non-pauper
class ; and they are the more significant when it is borne in
mind that the more numerous and powerful causes which are
supposed to he at work to augment the liability of the com-
munity to mental disease will affect the classes from which
I private patients come at least to an equal degree with, and
probably to a greater degree than, the classes which supply the
pauper patients. It cannot be said that they yield real siipport
to the opinion of the alarmists that so many more persons go
toad now than in the days of our grandfathers.

THE CADSATION AND PREVENTION OF INSANITY.

W

^^HnAgri cultural counties furnish a lai^er proportion of lunatics
^^^mui manufacturing districts, and those counties in which tlie
^^Wwges are low, like Wilts, a larger proportion than those in
which the wages are high. Low wages of course mean poverty
and bad nourishment, and lunacy shows a distinct tendency to
go hand in hand with pauperism. Moreover the stagnant, un-
intellectual life of an Bgiicultural labourer is less conducive to
uienttd health than the more active and varied intellectual life
evoked by the pursuits and interests of a manufacturing town.
Mental exercise is the true foundation of mental health ; and
when a person who by virtue of being bom of civilised parents
has inherited the mental organs and aptitudes fitting him for a
certain height and vaviety of moral and intellectual development,
makes no use of them, but allows them to waste and degenerate,
80 initiating decay of his higher nature, he is in favourable
conditions for the occurrence of some form or other of more
positive mental derangement. He is not like the savage who,
having no such inheritance, suffers not any ill consequences
from mental stagnation ; being the heir to ages of culture, h©
has the responsibihties of his inheritance ; he cannot divest big.
nature of the privileges of its higher birth, nor himself of the
duty to exercise them fitly, nor exempt himself or his posterity
from the sure penalties of neglect of them.

The caudid observer who surveya the ways of men in the
state of modern civilisation cannot choose but confess that
many of their most cherished aims are unworthy of the zeal
and energy with which they are pursued. They may be summed^ 1
up compendiously in the words ■' to get on in the world," h^\
which is mostly meant to get rich and to rise a step or two in''
the social scale. Without doubt it is a good and excellent
thiug that there should be so much desire and energy displayed
in straining for an aim of some sort, forasmuch as, were there
not, no progress could be made ; but it is often a grievous thing
as regards the individual and his family that his aims and work
are not more consciously and systematically altruistic ; that liw i
does not realise plainly that he is a member of a social body**]
^^ whose individual functions are subordinate to the welfare of the
^^nrhole. Hia practical worship being to get n\one^ tt.i\i e-ay^N "■*,,

1
1

ik^H

I

I

PATHOLOGY OF MIND. [oh,

attested aa real religion is, by faitli and works, and his professed
religion, not attested by faith and works, being to despise tbe
things of this world and to look upon his sojourn in it as merely
a preparation and a discipline for a life to come, his actual aim
is to serve two masters who require quite opposite services,
holding to the one without despising the other. Unhappily for
success in this course, euch a divided allegiance has been pro-
nounced by high authority to be impossible ; and the result of
the radical inconsistency of aims is a want of fundamental
harroony and sincerity of nature, which is a poor defence against
the assaults of adversity : like a house, the foundations of which
are not solidly laid on one consistent plan, it will be likely to
fall when the storm comes. A sincere and searching examina-
tion of the quality of the aims upon which he concentrates the
real hopes, aspirations, and energies of his life, and of the
foundations of the beliefs which, professing, he does not net
upon, and of those which, professing not, he does act upon,
were he capable of it, could not fail to reveal to many a
one how unstable is the foundation of liia mental structure,
and how ill fortified it is to withstand the stealthy advances
and direct onslaughts of disease,

It cannot be disputed that the pursuit in which a man is
engaged liabitually, which is ever in his thoughts, and to suc-
cess in which he bends all his energies, does modify his character,
and that the reaction upon character of a hfe spent solely in
the business of getting rich is hurtful. It is not only that
the fluctuations of fortune sometimes disturb or overthrow the
balance of a mind tliat is engaged in large speculations, or
that failure in some great crisis, frustrating the hopes and the
work of a life, prostrates the individual's enei^es and drives him
melancholic, but it is that the narrow selfishness of his life-aim,
sapping with steady certainty the feelings and responsibilities
of a larger human brotherhood than mere family clannishness,
weakens and withers the altruistic elements of his natnre, and
BO in his person deteriorates the nature of humanity. There is
uo more elTieient cause of mental degeneracy, perhaps, than the
mean and vulgar life of a tradesman whose soul is set entirely
a/ioji petty gains; who, under the sanction of the customs of

lY.] THE CAUSATION AND PREVENTION OF INSANITY. 136

his trade, practises systematic fraud and theft ; and who thinks
to outweigh the iniquities of the week by the sanctimonious
observance of the Sabbath. Such an one is not likely to beget
children of sound moral constitution ; and for him to hope to
found a family which shall last is little better than to hope to
build on quicksand a house which shall stand. The deteriora-
tion of nature which he has acquired will, unless a healthier
female influence chance to countervail it, be transmitted as an
evil heritage to his children, and show itself in some form of
moral or intellectual deficiency ; perhaps in extreme duplicity
and vice, perhaps in outbreaks of positive insanity.

The maxims of morality which were proclaimed by holy men
of old as lessons of religion indispensable to the well-being and
stability of families and nations, are not really wild dreams of
inspired fancy, nor the empty words which preachers make
them ; founded on a sincere recognition of the laws of nature
working in human events, they were visions of eternal truths
of human evolution. Assuredly the "everlasting arms" are
beneath the upright man who dealeth uprightly, but they are
the everlasting laws of nature which sustain him who, doing
that which is lawful and right, leads a life that is in faithful
harmony with the laws of nature's progress ; the destruction
which falls upon him who dealeth treacherously and doeth
iniquity, " observing not the commandments of the Lord to
obey them," are the avenging consequences of broken natural
laws. How long will it be before men perceive and acknow-
ledge the eternity of action, good or ill, and feel the keen sense
of responsibility and the strong sentiment of duty which so
awful a reflection is fitted to engender ? How long before they
realise vividly that under the reign of law on earth sin or error
is inexorably avenged, as virtue is vindicated, in its consequences,
and take to heart the lesson that they are determining by their
conduct in their generation what shall be predetermined in the
constitution of the generation after them ? Crime, vice, mad-
ness, every unwelcome sort of ill- doing, comes by law, not by
chance, not by casualty but by causality : " Shall there be evil
in a city, and the Lord hath not done it ? "

Religion, — Among the conditions of life ^\ic\L \\^n^ ^^\5^

7

I

PATHOLOGY OF MIND. [oa

influence upon character, either to strengthen or to weaken it,
must be recko»ed the religious atmosphere in which a person is
bora and reared. The mighty question of the working of reli-
gion generally, apart from any jiarticuhir form of religion, upon
the minds of men for good or evil I forbear to enter seriously
npon, not only because of tlie difficuUy and delicacy of the sub-
ject, but because it would be impossible to do justice to a matter
of such transcendent importance in a brief and incidental maouer,
even were the occasion and the ability ready. In the outset it
would be necessary to consider what effect a belief in the super-
natural, as almost universally harboured by mankind, has had
upon the growth and development of human thought and upon
tiie formation of human character; whether its tendency on the
"Whole has been and is now to streugthen the understanding and
to further its development, or to weaken and stunt it. "When
one looks at the desolating effects of superstitious customs based
upon beliefs in the supernatural among savages at the present
day, which must plainly shut out any chance of progress ao long
as they last, and must from the first have instantly and ruth-
lessly quenched any impulse of progress that might show itself
in a pai'ticular individual, the indisputable answer might seem
to be that the tendency had been banefuL If wo look again to
the earlier ages of Christendom, when Rome was ascendant and
its persecuting fires were in fidl blaze, and reflect that any
deviation from the routine of the established belief, were it ever
80 good, was zealously extinguished as a pernicious thing, — the
logical theory of the Eoman Church being that new doctrine
should be stamped out as a dangerous centre of infection, — wo
may imagine in a lame fashion how many excellent impulses to
new developments of thought were extinguished as soon as they
showed themselves.

Fnrthermoi'e, the celibacy of the priesthood and the numerous
monasteries that were thickly scattered over the country with-
drew from freedom of thought, from the true service of man-
kind, and from a legitimate share in the propagation of the
race, many of the best men and women of the age ; and the
rigid system of a uniform and changeless belief which waa,
irced and fixed upon the minds of men, barring all inquii

iriuH

w

I 111

,] THE CAUSATION AND PREVENTION" OF INS.iNITT. 137

into the phenomena of nature, couIJ not fail to prevent iulel-
lectual development. Poetry, painting, sculpture, and architec-
ture were the channels through which men of geniua found
ig outlets for the productive energies of their nature,
iut notwithstanding that in tlieir great works mankind happily
lined some compensation, the sceptical inquirer may ask
'hether the art of a gi'eat painter might not have heen put to
itter purposes of human elevation than to paint the same
,int3 over and over again ; and may hold that a few extraordi-
nary developments along the paths that were left open were not
au adequate set-off for the vaat amount of intellect which was
systematically repressed by the prohibitions of authority. Full
freedom for the entire race to search, and know, and work in
whatever direction inclination may urge or occasion invite
would seem to be now the most certain foundation uf human

ture were
^^■jsompensat
^^^^But notwi
^^Hpained so
^^^Krhether tl
^^^Rietter pui
^^Kgaints ovei

^1

But it is certainly not to be denied that a belief in a au]
natural intervention in human affairs might be nseful at
stage of human evolution, and indeed essential to social progress,
just as it is essential to a child's welfare to believe in and respect
its own parents, who may nevertheless he actually unworthy of
respect, and yet may be mischievous at a later stage when it
"laa done its work and undergoes decay, the intellect having

tgrown it ; the more so when it has been corrupted by the
interests of priestcraft and used to promote the ends of organized
imposture. The only present concern with the belief is to know
whether its influence upon the human mind is good or ill now ;
whether it helps or hinders intellectual and moral progress. How
can it help if it be not true and be known to he not true f To
affirm that the course of nature may be capriciously interfered
with at any moment by a power which is outside nature, and that
the observed sequence of events ia but a sequence at will, would
be, were it more than lip-doctrine, to take from man the most
urgent motive to study patiently the laws which are at work, in
order that he may bring his life into conformity with them, and
to weaken much or to destroy altogether the responsibility which
he should feel to make nature better through liis means, which Ive
■ill do best by making the best of himadS. It \a "O^ft "^^va &-o.^-^ .

PAXnOLOGY OF MIND. [cH&ifl

^^V'fmd ehould be tlie steadrast aim of innn, to carry oq in his future
^B 'evolution tlie evolution whicli has gone on in the past ; and this
^^~ he can do only by recognition of the uniformity of nature.
Prayers and sactiiices to fetishes, material or spiritual, will not
help, for neither prayer nor sacrifice will obviate the consequences
of want of foresight or want of self-disciphne, nor will reliance
on supernatural aid make amends for lack of intelligent will.
Herein lies the imputable mischief of prayer, that it is an imbe-
cility of will ; and when it acts, as it commonly does act, by
strengthening will in a reflex way to accomplish what is prayed
for, that is to say, through the energy imparted to will by the belief
that the prayer will be specially answered if it be well it should

tbe so answered, the sceptic might question how far it ia a benefit
to get such elfccts by an illusion — in a way which is like what
children " make believe " ? Whoever solicits by sacrifice or
prayer a happy issue of some venture, if he gets his wish, gets
■ it by the ordinary operation of natural law ; tlie god whom he
addresses may be deaf, asleep, on a journey, it matters not in
the least to the result. Nor ia there any more evidence that the
affairs of the spiritual world are not equally matters of law and
order; he who prays for the creation of a clean lieart and for the
renewal of a right spirit within him, if he gets at last what be
prays for, gets it not as a miraculous gift from on high, but
through tlie ordinary laws of moral growth and development, in
consequence of painstaking watchful nesa over himself and the
continual exercise of good resolves. Were he to fall down upon
his Itneea in the same way once or twice a day without praying,
and thereupon to calmly review hia past conduct and to make
firm resolutions to do well for the future in that wherein he had
done ill before, the result would be the same. Nor could it fail

• to be better for the strength and wholeness of human character
in the end that there should be entire sincerity in this matter.
Whatever then may have been its use in times past, what the
free inquirer has to consider now is, whether a belief in a fetish
does not mark a certain perversion or defect of intellectual deve-
lopment, and prayer or sacrifice founded upon it a certain per-
1 version or defect of will; whether the fostering of it does not
produce insincerity or mar unity of character; aud whether, as

^BVt.] THE CADSATION AND PKEVENTION OF IXSAKITY,

the human mind rises to a higher evolntion, growing in insight
by more exact knowledge of, and in power by correspODding
adjustment to, those all-pervading laws of order and harmony
through which alone the supernatural is manifest, the inviaihle
made visible, a behcf which is the prohibition of intelligent
inquiry and fatal to an independent human bearing will not
help but hinder intellectual development, will not strengthen but
weaken moral character. By holding notions whicli are not
founded on reason and cannot be reasoned about, inasmuch as
they are assumed to transcend or may actually contradict reason,
as a part of the common stock of its belief, the mind goes
counter to the very principles of its intellectual being, under-
mines its own foundations, proceeds with a fundamental incon-
sistency declaring itself in every phase of its growth. What
wonder that with the way so prepared and made ready it accepts

^with ease, when illness comes, extravagant delusions that ara ^
utterly contrary to reason I ^M

. But there is another side to the question which it would nofH
be right for tlie free inquirer to leave out of sight. It will bft •
said that the belief in an ever-present help in time of need is
a priceless stay and comfort in all the soitows, needs, afflictions
and other adversities of life, and that it sustains in the hour of
trial many a sore -stricken and lieavy-laden soul which, but for it,
would give way and strive no more. Certainly there are few ills

tthat have not some compensating element of good, and it were
Btrange indeed if a creed which has plainly been a necessary
phase of thought in the piBgress of mankind had been all mLs-
«hief. Here again, however, comes the solemn question for men,
whether it can be well for mankind now and in the long run to
bave the help of so consoling a belief if it be not true ? If it
fee confessed practically, as it is by tlie daily course of every
^an's life, that no miraculous intervention ever disturbs the
flerene and stern uniformity of natural law, that no helping
hand from on high is ever held out specially to raise up them
that have fallen, is not the harbouring of a belief in supernatural
aid likely to produce weakness by blunting the sense of respon-
sibility which a man has to be strong with his own, st^a-ftsgkv,
Uid the profession of it liable to become aa msvutexvV^ (k *.

E

PATHOLOUY OF MIND. [cH

hypocrisy iDJnvious to character? It may be a sad thing to
strike away that cratch which alone BceniB to support the feeble-
ness of humanity, but it is plain that for man to lean habitually
and lieavily on a crutch is not the way to learn to walk firmly ;
he will do thai best by risking many falls and by making more
skilful trials after eaeh fall ; and in like manner he who has to
learn and to do in a world of natural law will find his true
good in getting atrengtii tlirougli suffering, skill through trial,
victory tlirough obedience, and not in rehance on supernatural
interpositions wJiich have hitherto occurred for the most part
' where there was no need for their occurrence, the work being
' done without them, and have failed to occur where they were
most wanted — where their help would have been not superiluous,
but serviceable. It is easy to perceive that the savage is no better,
but worse, for the prayers and sacrifices which he makes to his
fetish ; and wlien the reason why he is not better but worse for
such ignorant reliance is sincerely considered, it will be seen
that it applies with equal truth to any one who puts faith in
any sort of fetish, it matters not whether spiritual or material,
niat a supernatural power will interpose to save a man's soul
alive who is not doing his own best to save it for himself ia
as mischievous a superstition, quoad the soul's welfare, as the
[ savage's superstition that his fetish will preserve his body from
' disease when lie takes no pains to keep it in health himself is
huitful to his bodily welfare: menial hygiene is impossible in
the one case as bodily hygiene is in the other.

No doubt it may be said that it would be impossible to
cultivate and satisfy the emotional element in human nature
and to kindle moral enthusiasm for the arduous toil of virtue
without a personal object of love and reverence ; but it is an
assertion which may plausibly be disputed. Buddha had no per-
sonal God, yet he was filled with a deep and calm emotion which,
diffusing itself through every fibre of his being, inspired a life
of unparalleled self-renunciation and virtue. Spinoza had no
personal God, being deemed an atheist by most persons, but lie
was unequalled in the simplicity and virtue of his humble Hfe,
in his sincere love of truth, and in his earnest devotion to it,
I ^11 assembly of freethinkers and atheists will be sure to applaud

^^Brj THE CAUSATION AND PREVENTION OF INSANITY. ■ U^|

^^^Biithiisiftstically all expressions of litiman sympatlucs, moral
^^Bantiments, aud virtuous reflectious. So long as maa has
^^^^i^aQic viscera lie will have eniotioa enough, whatever his
beliefs or disbeliefs may be: there need be no fear that he
will lose his emotional nature and become a hard intellectnal
machine when lie no longer puts up prayers or offers sacritices
to a personal God of like nature aud passions with himself. If
lie apply himself sj'stematically to that reverential study of
nature which it is the aim of science to pursue ; to that close
observation of «,od sympathy with her multitudinous and ever-
changing moods wliieh artist and poet cultivate ; if he cherish
that living interest in hnman sufferings, and aapirations, and
doings of which every being has more or less, but which rises
in some men to a lofty height of moral enthusiasm ; if he culti-
vate that sense of oneness with alt nature which philosophy
opens, and to which poetry gives its sublimeat expression — he
will have room enough for all the emotion which he can profit-
ably feel and express. When I consider this matter it always
appears to me that Shakespgare was not wanting in depth of
feeling or in profitable application of it, and I cannot sympathize
therefore with the apprehension that human nature will be robbed
of its emotion so long as it has the whole of nature, physical
and human, to spend it upon.

It is purely a gratuitous and unfounded calumny to impute that
man who has risen to the height of his present moral stature by
feeling with his kind and worldng for it, will cease to feel with
it and to work for it when he ceases to pray to a personal God

»who has created countless multitudes of his kind to foredoomed
Iwture through all eternity for sin of which they are innocent !
2f a crowd is assembled to see a brave man fling himself into
the raging sea and battle with its wild waves in order to save
human life, or do any other feat of danger and skiU — be it only
to chmb a greasy maypole — we observe how excited and sym-
pathetic it becomes ; and shall we suppose that the long toil of
humanity along that most steep and arduous moral path which
leads to its higher evolntion — the failures of those who fail and

ktha successes of those who succeed — will quicken no fecVvii^
kiiidlc no enthusiiisra? It is absurd \,o \\\mV ^\'jS. yo».iA-.wA

PATHOLOGY OF MIND. [nup.'H

will cease to feel emotion, even though it should say in its hDart
that there is no personal God; it cannot help firing morality
with emotion ; aud it may be that a healtliier feeling will be
quickened and a sounder emotion stirred when it ia no longer
infected by the taint of superstition. If it come to pass that
man is robbed of that narrow and intensely personal feeling
which is poured out in apprehensive wails about the salvation
of his own soul, or iu emotional shrieks by writers of the
spasmodic and fleshly school of poetry, or in morbidly subtile
analysis of overstrained feelings of any sort, there will be no
harm done ; for it ia a sort of emotion that is as unwholesome
as a hysterical ecstasy. Let him attain instead to that calmer,
deeper, wider, and healtliier emotion which is subordinated to
pure insight into the harmonies of nature and to philosophical
survey of its serene order, and is applied objectively to give
warmth of tone and colour to their expression in words. The
creed of nature is not shrieking self-assertion, but serene self-
Eurrender ; not man against the universe, but man as a part of
the universe ; not individual life with the single aim of securing
a blissful immortality, but individual life in wholesome subordi-
nation to the general life.
' In matter of fact it may he doubted whether any one ever
I does feel the strong personal love of a superuatural power which
I be pei-suades himself that he feels ; whether it is not a delusion
and a snare ; whether, when he imagines he has wrought himself
into the proper emotional mood of mind, he has not really
wrought himself into an artificial, vague, and somewhat morbid
state of feeling, which ia by no means so holy as he believes.
How there can be the definite relation of a genuine healthy feel-
ing between a finite natural being and an infinite supernatural
being passes comprehension when the attempt is sincerely made
to realize what is meant. It would be to feel the nnfeelahle,
to know the unknowable, to limit the illimitable — a contradic-
tion in terms, a nonsense.

Here I am brought to tfike notice of what appears to be

Boraetimes a great evil incident to the ordinary teachings of

religion — namely, the extreme stress which is laid npon the

, importance of the individual, the consequent habit of looking

f

,] THE CAUSATION AND PKEVESTION OF INSANITY. 1J3

to the welfare of his owu sonl as his chief concern, and the
■cultivation of a regular introspection of his feelings aa a means.
Al! these things are adapted to develop an exaggerated self-feeling.
The prohings of the heart, the gloom of repentance, the stings of
remorse, the musings of meditation upon matters of conscience,
which ate fostered as signs of a keen and sensitive conscience,
■ are often the unwholesome outcome of an exaggerated self-con-
tjMjiousness, and are more likely to lead to madness than to good
telations and sound work in the world. One notices a marked
sulijective pha-se of feeling iu most persons soon after the
development of puberty, shown in indefinite longings, dreamy
poetical moods, and all sorts of vague aspirations ; consequently
it ia a period of life when the miod is in a state favourable to
introspection, when it easily acquires the habit, and when the
habit runs quickly to excess. Women are naturally more prone
to religious worship than men, and more apt to fall into a
morbidly subjective habit, first, because of the preponderance
of the affective life iu them, and, secondly, because they have
not the distracting and connecting and intellectually hardening
influences of outside interests and pursuita which men have.
If unmarried women chance to come, as by reason of these
conditions they are apt to do^ under the ignorant and misap-
plied zeal of unwise priests who mistalie for deep religious
feeling what is really morbid self-feeling springing at bottom
from unsatisfied instiiict or other uterine action upon mind,
the mischief is greatly a^ravatcd.

It were well if those who make it their business to guide
the consciences of mankind through the manifold changes and
chances of life were to be at the pains to inquire how much
supposed religious feeling may be due to physiological causes,
before they sanction or enjoin a repeated introspection of the
feelings. He whose every oi^an is in perfect health knows not
that he has a body, and only becomes conscious that he has
organs when something wrong is going on ; in lilie manner
a healthy mind in the sound exercise of its functions is little
conscious that it has fechngs, and only gets very self-conscious
:When there is something morbid in the processes of ita actlHvt^ ,
lie ecstatic trances of such saintly ^voale^l aa Ci^^ecvaa *«.

PATHOLOGY 01>' MIND. [oHJ

^^m Sieuiie aiid St, Theresa, in which they believed themselves to

^K be viaited by tlieir Saviour and to be received aa veritable

^^T spouses into his bosom, were, though they knew it not, little

else than vicarious sexual oi^asm ; a condition of things which

the intense contemplation of the naked male figure, carved or

Bculptured in all its proportions on a cross, is more fitted to

(produce in young women of susceptible nervous temperament
than people are apt to consider. Every experienced physician
must have met with instances of single and childlesfl women
■*ho have devoted themselves with extraordinary zeal to
liabitual religious exercises, and who, having gone insane as a
culmination of their emotional fervour, have straightway ex-
hibited the saddest mixture of religious and erotic symptoms
— a boiling over of lust in voice, face, gestures, under the pitiful
degradation of disease. On such persons the confessional has
Lad sometimes a most injurious effect, more especially in those
churches which, aping Romanism in their ritual, have not placed
confession under the stringent regulations and safeguards with
which the lloman Catholic Church surrounds it. The fanatical
religious sects, such aa the Shakers and the like, which spring
up from time to time in comraunitiea and disgust them by the
offensive way in which thoy mingle love and reJigiori, are
inspired in great measure by sexual feeling: on the one hand,
there is probably the cunning of a hypocritical knave or the
self-deceiving duplicity of a half-insane one, using the weak-
nesses of weak women to minister to his vanity or to his lust
under a religious guise ; on the other hand, there is an exag-
gerated aelf-feeling, rooted often in sexual passion, which is
unwittingly fostered under the cloak of religious emotion, and
which is apt to conduct to madness or to sin. In such case the
holy kiss of love owes its warmth to the sexual impulse which
iuspires it consciously or unconsciously, and the mystical
religious union of the sexes is fitted to issue in a leas spiritual
anion.

Without doubt an excessive development of the emotional life
in any other direction would be equally pernicious. All that the
unwise religious teacher can be blamed for is his disposition to
fasier the ^oistdc development of emotion, without considei "

1

Q «> ^H

I

THE CADSATION AND PUEVEXTION OF INSASITY. 145

its real origin, by the overwhelming importance which he
Lchea the individual to attach to himself and bis destiny.
'Instead of urging him to lessen the gap between himself and
nature until he loses self in a sympathetic onenes3 with nature,
he stimulates him to widen it more and more until he rises to
the insane conceit of himself as something entirely distinct from
nature — an unrelated, spiritual essence, for whose benefit the
univerae and all that therein is has been speeially created.
Aasurerlly were not man now, as he always has been, instinc-
tively wiser than his creeds, were he not moved by a deeper
impulse than consciousiiesss can give account of, he would
make no progress in evolution.

On comparing the best pagan modes of thought with Cliristian
modes of thought a doubt might be raised whether the latter
have not sometimes been less favourable to a calm and stable
mental development Conti-ast, for example, the widely different
views and feeUngs with which death was regarded. To the pagan
it was the twin brother of sleep, the youth with inverted torch,
the natural rest at the end of the long day's task of hfe which
the wise man would not fear, but welcome ; to the Christian it
was presented in all the horrors imaginable, as the consequentio
and the punishment of sin, the king of terrors, the last enemy,
the opportunity of exulting fiends to clutch their shrieking prey,
the possible gate to ui^peakable torments through all eternity, I
find it impossible to conceive the countless hours of torment,
the unspeakable agony of mind, which tliis doctrine must have
caused since it was fii-st propagated : what quivering reflections,
what keen anguish of remorse, what agonizing apprehensions,
what torturing self- examinations, what appaUing fears have been
occasioned in anxious and tender consciences by a doctrine
which, far outdoing in barbarity the most barbarous superstition
that savage ever conceived, is still preached frani a thousand
pulpits in every civilised country, notwithstanding that there
is not a person of sincere understanding who rigorously analyzes
his thoughts and sternly realizes what the doctrine means can
say from the bottom of his heart that he believes it. Hope and
fear, which are baaed upon the self- conservative instinct in ita
relation to the future, are two most \iQweilM\ ■yasftXoii?. \w\«is»5«».

w

PATUOLOGV OF MIND. [uu

nature, and it is upon them that religion Iiaa fasfuned and works
with all the powerful machinery of ita eysteni ; its aim and
effect being to produce not wholesome subordination of feeling
to reason, but an unwholesome predominance of emotion.
Happily human conduct has again shown itself wiser than
human creed : men concern themselves more about the most
trivial events of the actual to-morrow than about the most
momentous issues of the possible life to come ; motives lose
force in proportion as they recede in distance ; and the fear
punishment and the hope of reward after death, which always
seem to be possibilities afar off, do not work with any force
upon the hearts of the vast majority of those who profess to be
affected by them. "Without doubt it does happen from time to time
that a person of anxious and foieboding temperament, brooding
over Ilia sins, falls into a sort of spasmodic horror of the dread
eventuality of eternal damnation, and becomes melancholy-mad,
believing himself to have sinned beyond possibility of forgive-
ness and to be eternally lost ; but in such case the religious
delusion is oftentimes no more than the convenient and suBi-
cient shape which the mental depression takes in order to get
adequate expression, and it is not unlikely that the person
would have equally gone insane and have had some other
gloomy delusion if he had not known religions doctrine. A
more deep and widespread mischief attributable to the doctrine
of future rewards and punishments, is the deadening of the
feelings and the blinding of the intelligeuce of men to the
certain laws by which their sins, errors, and ill doings of
all sorts are avenged upon themselves or upon others in this
world, and to the stern responsibilities to observe and
which the reign of natural laws imposes upon them.

One consideration more, and I pass from this subject. Loolt-
ing to the exalted moral code which is inculcated as the essen-
tial rule of Christian practice, some attempt should be made to
weigh the actual effect on character of the solemn profession of
principles and precepts which appear to be too exalted to be
reconciled with the exigencies of practical life. The Christian
religion is a religion of passivity rather than of activity

ISC

4

this ■ m

k religion is a religion oi passivity rainer tnau oi activity; ib ^h
teaches mankind hoiv to suffer better than how to do in thbt^^^

».] THE CAUSATION AND PREVENTION OF INSANITY.

^^nrorld ; and if its principles were faithfuliy carried out in prac-
^^Hbce they could not fail in the end to leave the good man at the
^^^bercy of the koave. It was a gospel which could be preached
with more consistency and sincerity to a world which was thought
to be close upon its end, wbeu nothing better could be done than
to prepare for it, than it can be to a world which has gone on,
and goes on, as if it were never coming to an end. In commerce,
on the exchange, in political life, in all the departments of prac-
tical activity, a man must have another creed and another prac-
tice. On the one hand, then, he fulfils, as essential to liis present
well-being, the law of natural selection, by which the strong
takes advantage of his strength and the weak is made to pay
the penalty of his weakness ; on the other hand he profea^es, as
essential to his eternal well-being, the altruistic doctrine that he
should not lay up for himself treasure on earth, that he should
prefer his brother in all things to himaeif, that when he is smit-
ten on one cheek he should meekly turn the other also to the
smiter. But it cannot be conducive to the strength and harmony
of intellectual and moral character that there should be a funda-
mental contradiction between faith and works whereby life is
made a sMfting compromise, or a systematic inconsistency, or
sometimes an organized hypocrisy; and one cannot help thinking
that it would be well that, instead of a rule of life consiatiug
of natural selection irregularly and occasionally tempered by
Christianity, there should be established a fundamental harmony
between religion and practice. If accepted doctrines will not
grow to new requirements they must be changed, since no doc-
m trine can claim to bind rigidly the belief of mankind for all time,
■^■^ can BO bind it without putting a stop to mental development,
^^v These general reflections upon the working of religion upon
"^ ■ liuman chamcter will indicate how little use it is to discuss, as
is sometimes done, whether insanity occurs more often in one
sect of Christians than in another. There are no statistics upon
which we can venture to place the least reliance to decide the
question. Any sect which fosters habitual emotional excitement,
ov lends its authority to extraordinary displays thereof, will

■ikrour the. production of instability of mind and ats -^TeKa-^joavi
|b the easy overthrow of its balance. ^Hwo. ^^\e TeNA^w\ "^

1

PATnoi-OGY OF MIND. [cbap.

^^B niain]y a social observance which it beseems a person of respecta-
^^M bility, willing to staud well with his neighbours, to conrorm to,
^H it will in thia country moat likely be the religion of the Church
^^B of England, which suits well success in life and a respectable
^^B Bticial position ; not exacting any show of zeal from nor im-
^^P posing any galling yoke upon its members, for the most part
eschewing anything that is extreme, claiming only from its
bishops that they should evince no tendency to deviate into
originality or zeal, and, as an established religion in alliance with
Bocial institutions and the governing classes, aiming to preserve
I the established state of things. But it must honestly be ad-
mitted that this Chiirch does not reach those who are in poverty
and affliction, whose daily lives are daily hard stru^lea to live,
who most need a gospel or glad message to solaee and eustaiu
them. These, if they profess any religion at all, belong mostly
to one or other of the two religious divisions into which the two
extreme and opposite parties in the English Cliurch insensibly
pass — to Roman Catholicism at the one end, or to one of the
sects of Dissenters at the other end ; for the Church of England
stands as a Church of passage between Homan Catholicism and
Dissent, as all forms of Protestantism are logically creeds of
passage between Eoman Catholicism and a complete emancipa-
tion from belief in the supernatural. In weighing, then, the
effect of religion as predisposing or not to insanity, we have
practically to do with Eoman Catholicism, actual or abortive,
or with Dissent in one or other of its forms.

There is no reason to believe that tlie Eoman Catholic religion
has any special tendency to produce insanity among those who
are within its pale. It does not encourage throes of emotional
spasm, its infallibility is a fast anchor for distressed souls to
hold by, and the morbidly tender conscience is eased sometimes
of the burden which weighs upon it by the clear sense, calm
judgment, and trained sympathy of an experienced priest who
dissipates exaggerated apprehensions and administers fitting
Bpiritnal remedies.' Moreover, the assured belief that sins can
be remitted through penances, and that the priest is divinely

' Tlmt is one KJdo of the matter ; an injudiciona or dishuncst priest)
jroiiiniJ'iTig morbid outpourings, may do intmite iniscliief.

L

^_ vei

Pi] THE CAUSATION AND PREVENTION OP INSANITY. liSfl

empowered to gi'ant absolutioii from them, will not fail to have
a like comforting effect. A priesthood standing as mediator
between the trembling slave and his offended master, and in-
vested with a delegated authority to mitigate terrors, may not
be an altogether hm-tful institution where a belief in the capri-
eions intervention of a supernatural power in human affairs
prevails : it is a compensating artificial support for the intellec-
tual feebleness and moral impotence produced by a debilitating
creed, the necessary complement of it. No unbiased mind can
doubt that the unquestioning faith demanded by priests and
accorded by disciples, and the pretence that all truth has been
delivered into the keeping of the Church from the beginning,
are inimical to the true interests of mankind, a hindrance to its
progress, and a standing menace to its dignity ; not a whit less
so than the unquestioning credence and trembling submission
which the savage yields to the claims of his fetish. Savage and
Catholic may boast of being untroubled by doubt, but they gain
their peace of mind at the cost of an arrest of the development
of the understanding.

The philosophical observer who has given close attention to -I
the extremer forms of Pi-otestantism in their relation to charao- '
ter, snch as are known as Evangelicalism, must have noticed
how often they go along witli an extraordinary insincerity or
actual duplicity of character, I mean not to insinuate that the
tendency of an evangelical faith is to engender duplicity of
character; the reason of the connexion probably is that per-
sons of that character are attracted naturally to a form of creed
which, making large use of the sort of emotion that springs
from self-feeling, yields them the gratification of a suitable
emotional outlet, and by the habitual employment of a con-
ventional religious phraseology keeps out of sight, or at any
ite veils thickly, the gross variance between high profession I
td low practice which the use of a common language could 'I
■Bot well fail to bring clearly home. They use conventional
language without ever sincerely analyzing itft meaning, because
they find in it fit expression for certain narrow feelings that
liave been associated with it, and are more comforted h'^ ^''^^.^

^^__^iiavB ueen assoiiiLLeu witii iii, hihi uie luoiu lioiiiiinieu. «^ i."-"!! ^^^

tr-—M

150 PATHOLOGY OF MIND. [chap.

shibboleth to them, the sign of special grace, like that blessed
word Mesopotamia, the sound of which yielded so much comfort
to the old woman of the village. They are not the conscious
hypocrites which they seem; they are inconsistent without
really feeling their inconsistency ; the two diverse developments
of their nature do not interwork, and they go on with an in-
coherence of character which they never realise, not otherwise
than as an insane person will go on quietly in a daily routine
of life that is utterly inconsistent with a fixed delusion which
he has all the while concerning himself. A nature of this sort
is well fitted to breed insanity ; my experience, indeed, has led
me to look upon it as a singularly effective cause of degeneracy
in the next generation.

Admitting that a person's religious profession is very much
the expression of his character and of its mode of development,
and no more therefore the real cause of his insanity, if he falls
insane, than religion is the real cause of the insanity of one
whose overweening self-conceit has culminated in a delusion
that he is an inspired prophet — the fundamental tendency in
each case having fallen upon conditions favourable to its morbid
growth in the religious views and practices adopted— it might
still be argued that any body of men which separates itself
from the rest of the world as a specially favoured religious
sect, hugging itself in the belief of the exclusive possession of
vital spiritual truths which the rest of mankind fail to apprehend,
and living apart as a sort of chosen people, adopts a course
which is injurious to character and errs from the true path of
healthy progress. The pride of opinion, the conceit of supe-
riority, the narrow and complacent spirit of the sect react upon
the characters of the individuals who compose it, and, isolating
them from wholesome relations with their kind, instigate these
sectaries to a special and unsound mode of thought concerning
the world and their position in it. Moreover, their conduct is
apt to suffer : there is no small danger of their devotion being
not to truth, but to sect in the first instance, and of their
acquiring an esoteric and an exoteric conscience ; the former for
use among their co-religionists, and the latter, of quite another
kind, for use among the rest of mankind. These sectarian divi-

IV.] THE CAUSATION AXD PREVENTION OF INSANITY. 151

i

^^Haons in the intellectual and moral spliere are as injurious
^^^Kue religious progress as the divisions of a nation into tribes
^^^lospicious of or hostile to one another would be to the true
interests of the nation : we may compare them to the divisions
into scattered tribes which prevailed among manldnd in the
early stages of its progress, before it had reached the height of
national union and had grown to the apprehension of the higher
moral relations which such an union involves. "Wliat the
strength of the religious bond is, how effectual to hold a people
together, ia well shown by the example of the Jews, who,
having no state, no country, no cominon language, no bond of
unity except a common religious belief kept alive by a common
ceremonial, have remained a distinct people until this day, The
Armenians furnish another but less striking instance of the
strength of the religious tie.

• Theoretically religion should he the hond of unity to gather
all mankind into one brotherhood, linking them in good-wdl and
good work to one another ; whereas practically it has hitherto
been that which has most divided men, and the cause of more
hatreds, more wars, more disorders, more persecutions, more
bloodshed than all other causes put together. In order to pre-

» serve peace and order, therefore, the state in modem times iias
been compelled to divorce itself practically from religion and to
leave to each sect Hherty to do as it likes so long as it meddles
not by its tenets and its ceremonials with the interests of uivil
government. Toleration of all rehgious doctrines and practices,
BO long as they do not touch the practical concerns of life, has

» become the necessary maxim of state policy ; very much as in a
lanatic asylum, where it is found impossible to make the inmates
think in a common way to common ends, full liberty of delusions is
left to each inmate so long as he does not act upon them in such
a way as to interfere with the order of the establishment. It ia
not a little inconsistent that the sects should raise the outcry

I they do against irreligion which are themselves the negation of
■teae religion. Then again, what high treason against humanity
^ve their partizana perpetrated I They have robbed it of its
highest achievement, the most perfect Hfe of self-renunciatioa
'which has been lived on earth, by translaUng \t ^Yon\. a.\v'>»svwi. \»

15^H

:ciu^i|

I

I

PATilOLOGY OP MIND. [c

a divine category, and so have doDe their best to wither its
liopea and paralyze its efforts to repeat tlmt great achieveraeut

But I must not continue reflections which would carry me far
beyond the scope of this work : the end of the whole matter
for the present is that if the prime condition of true religion be
to get quit of the belief of special supernatural interventioua
in human affairs, physical or moral, the maintenance of such
belief cauoot be a strength but a weakness to the mind, and eo
fiir will predispose to derangement of it

SJumtion.—Jiftixi in importance to tlie inborn nature is the
acquired nature which a person owes to his education and train-
ing : not alone to the education wliich is called learning, but to
that development of character which has been evoked by the
conditions of life. Undoubtedly a person may be well-educated
by experience who can hardly read or write, as it happens
Bometimes that a person lias a great deal of learning and is
nevertheless very ill-educated. A\'riters on insanity discuss the
question whether educated persons are more liable to go mad
than uneducated persons, agreeing not always in their conclu-
sions ; and in the I'eporta of lunatic asylums numerous statistics
are given to show bow many patients have received a "good"
education aud how many have had little or no education. The
statistics are of no value, and the speculations founded on
them, how ingenious soever, must be I'ain until there is some
agreement as to what is meant by good education.

Many persons consider it no true education which does not
instil into the mind of youth from the earhe,st dawn of intelli-
gence the doctrines and the stories of the Bible as most sacred
truths, having an authority which reason can add nothing to if it
confirm them, nor take anything from, if it contradict them ; and
until lately it was generally thought to be a proper and suffi-
cient education to teach boya to understand the Greek and Latin
languages and some mathematics, and girls not even so njuch as
that. If what has been before said concerning a belief in the
supernatural he tme, and if man's power of acquiring knowledge
and weighing evidence through reason is not checked and con-
trolled in the most arbitrary manner by revelation, it is plain
thst a ^eat part of the human race, instead of being educated,

ft.] THE CAUSATION AND PREVENTION OF INSANITY.

has been persistently miseducatetl for a long time ; and if recent
reforms in the kind of instruction given in schools be just, it is
plain that past generations had nothing like a proper education
ill that wherein they were not miseducated. The rii^ht questions
then for writers to discuss would ha not whether education has
increased or lessened the liability to insanity, but whether the
miseducation in Togue has enervated or vitiated hnman thought
and feeling and so predisposed to disorder of them, and whether
a better education may not couuteract the evil. For it will be
admitted on all hands that the best education would be the
strongest barrier against mental derangement which it would he
possible to raise ; a pity it ia therefore that men are not agreed
as to what is the best system of education.

For my part I desire to think that there is a great deal of
undeveloped mentality in the moss of mankind which past
education has scarcely touched, but which an improved and ex-
tended system of education will bring by degrees into activity,
to the great profit of the race in its future travail. The basis
of a better system must be a sincere recognition of the reign of
throughout nature, mental as well as physical, and of the
lomentoua responsibility to act in conformity with knowledge.
No one can doubt that the study of the natural sciences, by
which are made known the complex operations of laws in tlie
varioiis domains of nature, does furnish a valuable training of
the intellect by teaching how to observe accurately, to reason
soundly from facts, and to think sincerely ; truth in them being
pursued entirely for its own sake without regard to preconceived
opinion or to the claims of authority, and patience in inquiry,
humility of attitude, and veracity of thought being es.sential
quaiities in the true servant and interpreter of natura More-
over, new insights into the secrets of nature lead to new adjust-
ments on the pai-t of man to his complex surroundings and to
corresponding new gains in power : his best gains arc to the
best gain of nature, and the best gains of nature are liis true
gain. If he fails by searching to find out a law and so acts
ignorance of it, or if, knowing it, he disobeys it recklessly
wilfully, he certainly brings punishment upon himself or upon,-
UhL'i'Si he is contending wilh an ad\etsa.vy n\\w \i.\ii.\Xve,^

the

rue ^™

I

i

WtBi PATHOLOGY OF MIXD. [':H««I|

mistakes nor overlooks them, foregoes no advanti^e, feels no pity,
inexorably exacts the full forfeit of failure, and wlio is not to be
bribed by offerings nor placated by prayers : he must suQer for
his sin, and, learning wisdom through suffering, do more msely
for the future in that wherein he erred in the past. What moral
discipline can he better than that; what more Buited to make
men take earnest pains to do well? Actual intercourse with
nature is the best schoolmaster, teacliing, as it does, the lessons
■of experience winch actually do guide men in tlie conduct of
life; for the maxims of worldly prudence according to which
tihey act in their dealings with one another and in their worldly
afiiiirs are sincerely Ijeld and faitlifully observed ; being founded
upon experience of the harm wliich ensues from disregard of
them, they have a real and constant inlluence upon conduct
which the maxims of philosophy and even the doctrines of
religion have not. Were these doctrines based securely and
plainly upon the same positive basis of experience, and were
they to appeal as directly to the reason of mankind, it is pro-
bable that there would be the same unwillingness to perpetrate
the folly of disobeying them.

It may be alleged, no doubt, that the formation of character
implies much more than a mere increase of knowledge, whether
by the inductive or other method, and more than an increase
of the intellectual power which increased knowledge confers;
but the answer to that objection is that the knowledge of the
reign of law in nature does guide our impulses to wiser and
therefore bettor action, that good action promotes in time corre-
eponding moral development of character in the race, and that
this moral effect is multiplied ty the recognition of the reiga of
moral law in the domain of human evolution.^ The repetition

' I have not the loaBt intention to argue that the stiidj of the physical
ecienoes is a moral regenerator of the individiiul who parsues it, or tlint
soientifio men aro any tnoro free tlian other people from envy, jealousy,
vanity, and other mean piisaions. On the contrary, they aeem more prone
to them, probably because they are few and come into close competition.
Moreover, I do not fail to recognba tho folly of the aoientiBc siiperBtition
!ntart»ined by some persons, that acientifia study is a particularly exulted
_u v.-_,. :. , ,..,,.__,._ - ' ■■ ,ufd hehi" ■

labour, which is of unspeakable value, and should be held in siiprenie r
verance apart from its beariiig on human welfare. Science is siinply
ioowJedge, and is neither mote nor less valuable than other kuowledj^e

f.] THE CAUSATION AND PREVENTION OF INSANITY. 1,

of good action generatca the liabifc of doing well, fiinetioii d(
veloping stractura, and tlie habit of doing well generates
moral feeling in regard to euch action, which it becomes at laat
a pain to go against Those who, following Comte, insist that
the impulses to aetion come not from the understanding but
from the feelings, and thereupon go on to affirm unreservedly
that the undei-standing has nothing to do with the springa of
human conduct, have stopped at a half-truth which Comte
would have repudiated. "Man," he said, "becomes more
sympathetic in proportion as he becomes more synthetic and
more aynergetic : " in other words, in proportion as he constructs
for himself a truer and more complete theory of his relations to
nature, physical and human (synthesis), and acts more faitlifuUy
with and for his kind {synergy), so will he develop in his nature
a quicker and fuller human sympathy and have stronger moral
impulses springing therefrom. The enforcement of sanitary
measures to improve the dwellings and the condition of the
poor might have been preached in vain had not infectious fevers
bi'cd in pestilent quarters taught the lesson of a common
humanity by a very effective sort of sympathy between man
and man — the contagion of disease ; but now that the laws of
health are becoming known and public efforts are being sys-
tematically made to get some observance of them, we perceive
that a feeling of repugnance to disease-breeding conditions, a
sort of sanitary conscience, la gradually being engendered, out
of which we may expect to spring more urgent impulses to do
away with them.

This example of what is going on now may serve to illustrate
how the moral sense of mankind was originally developed out
of moral action ; for the moral sense embodies in its nature and
displays in its function the kind of action through which it
has in the long course of ages been ingrafted as an instinct or
feeling in the human heart ; the altruistic action having been first
entered upon in a feeble way fi'om a dim perception of its
vice to the social life, and continued because of the unity and

that lielpa men liow to live. Moral progress must bo looked Cor parlicuUrly
' tlie pursuit of social and moral Hcience, Biid in the working of general
intiiiu knowledge upon the raue griidunlly thrwig^i ftei\ci&v;\o\\*.

^

i

^V IK

^K atr
^K oh

I

1S6 PATHOLOGY OF UINO. [cD^fl

atreiigtli which it gave to the community. In Hke manner we may
oliserve in the process of deterioration oC character how habitual
action modifies feeUng and desire : no one ever becomes suddenly
monster of baseness, losing all sympathy with goodness and
evincing a positive rehsh for iniquity in an instant, any more
than he gets any other acquired taste in an iustaut ; but by a
course of wicked deeds, the first of which was done perhaps
against the grain under some strong temptation, the next with
less repugnance, and the next more easily still, such a deteriora-
tion of nature is wrought by degrees in him that the evil stirs
not a repugnant feeling, but nn actual desire to do it. Good
impulses to act come out of good feelings as bad impulses come
out of bad feelings, and good feelings are slowly ingrained in
human character, become instinct in it, by a course of wise
doings. Should it ever come to pass that mankind attains to so
complete a knowledge of all the laws of nature in its manifold
and complex operations as to perceive instantly tlie right way
of obedience for wisdom to take in any event and to take it,
there will be developed a conscience so calm, so strong, so all-
embracing that to sin against it will be looked upon as crime
or madness : the freedom of the will will be tho freedom of

It may he objected that men obey the law of gravitation
every moment of their lives without having any moral feeUng
generated with regard to it ; but the objection, when fairly con-
templated, is not of much weight. In the first place, the law of
gravitation is a physical law, the violation of which is followed

I directly by punishment to the individual, whereas the conse-
quences of the violation of a mora! law necessarOy affect others
and are usually remote ; the individual who breaks it Injm-es
not only himself, but the society of which he is a member —
that is the essence of the transgression : he strains the bond of
the social state. By reason of the community of kind in men
and of the sympathy which there is between them as members
of a common body who, though having different ofRcea, serve
a common end, and therefore sufi'er in common from individual
"wrong-doing, their sympathies and antipathies are necessarily
BtiireA, and feelings of approbation of what is done right and

^■ilv.] THE CAUSATION ASD PREVENTION OF INSANITY. IST^H

of diaapprobatiou of wliat is done wrong accompany obudieiice
lo and infraction of moral law. The difference between a
piiysical law and a moral law ia this relation is much like tlie
diflVrence between a mechanical structure and a living organism :
tbe whole house may not be much hurt by the decay or injury
of one or two of the bricks of which it is built, but the whole
body will not fail to be affected by the decay or injury of one
or two of the organs which constitute it. To violate the law
of gravitation is a foHy ; to violate the moral law is a bLu, for it
ia an injury to the social organism : the former offence is a sin
against science, that is, knowledge; the latter ia a sin against
con-science, that ia, that essential human feeling which has been
sublimed out of tbe relations of the communion of men in the
social state. Of the social commimion of men the moral sense
is the highest fragrance, as the religious conscience is the highest
fragmnca of the communion of the saints, ^^B

When Christians assemble together in holy communion ^Q^^H
break bread in memory of the life and sufferings of their^^H
Saviour, they solemnly i-enew and attest tlieir conviction of
the essentiality to human welfai'e of the sublime moral truths
which he proclaimed in speech, realised in his life, aud suf-
fered for in his death, and quicken their sense of them, which
is apt to grow dull in the rude conflicts of the world. They
get strength and comfort to go on the narrow way of upright-
ness from this assembling of themselves together in solemn
meeting, out of their consent of faith and the infection of
sympathy; for they are beings of the same kind, struggling
with the same trials, bearing the same sorrows, aud looking
forward to the same end of their labours under the sun. But
it cannot therefore be argued that there is anything which
does not come by ordinary mental laws, anything supernatural,
in the moral enthusiasm which is kindled in these circum-
stances; if a number of persons were gathered together in
the same sympathetic way to fan some unwise emotional ex-
citement and to do some foolish tiling, as for example to dance
and shake furiously after the manner of the Shakers until
they were exhausted, the excitement would be augmented, and
the infection of it would spread by Eympat\\''f mWve SiWOift '«^'j -

^^ The

PATHOLOGY OF MIND. [c

:«^|

I

I

The infection of emotion has, as liistoiy shows, given rise to
many moral epidemics. However plainly wo acknowledge the
operation of law in human thought, feeling, and conduct, there
roust always be, so long as men continue to be of the same
kind, and susceptible tlierefoi-e to the infection of a couiniou
emotion, so long its no favoured ones among them rise to the
level of a higher kind from which they can contemplate apart
with God-like serenity the doings of their furmer fellows, a
qui(^ feeling of personal and social concern with respect to
the operation of moral law which there ia not with respect
to the operation of physical law ; and from this feeling it ia
that we derive the ethical impulse, tlie imperative moral man-
date, wliich accompanies the perception of the right way to take
to promote human weal and dictates the duty to take it
f It may be anticipated perhaps tliat the time will come, though
it is yet afar off, when tlie feelings of anger and retaliation
which are now roused by criminal and vicious doings will be
extinct, and when those who perpetrate them will be thought so
in.'ational as to be looked upon with the same feelings with
which lunatics are looked upon now.^ In this relation it ia
instructive to take notice how complete a revolution in the
feeling with regard to the insane has taken place within the
last half century, with increase of knowledge of what insanity is:
their irrational beliefs and turbulent deeds roused indignation
formerly, and were dealt with by harsh measures of punishment,
as if they were voluntary ; now, however, since better know-
ledge of insanity has been gained, those who have to do with
the insane look upon their delusions with curiosity or compas-
sion, and are not moved to anger by their perverse and violent
deeds; however much annoyed or distressed by tliem, they
would no more think of getting angry and retaliating by
punishments than they would think of punishing an unwelcome
rainy day ; but it is instructive also to note that the old
sentiments still linger in the breasts of ignorant people, and are
vigorously expressed in outbursts of angry vengeance whenever
an insane person who has done homicide is rescued from the
gallows. It were a good thing if men could reach the same
height of philosophy in contemplating the evil doings of their

IV.] THE CAUSATION AND PREVENTION OF INSANITY. 159

fellows who are not in lunatic asylums : if instead of being
embittered by treacherous dealing, afflicted by evil speaking and
slandering, soured by ingratitude, made revengeful by wrong,
angered by stupidity, they could look upon such things as
natural and inevitable events, much as they look upon the
vagaries of insanity or upoii bad weather, and be nowise dis-
quieted by them. Such attitude of mind need not in the least
preclude suitable steps being taken to frustrate acts of treachery
and to render criminals harmless, any more than it now pre-
cludes the adoption of the necessary measures to place lunatics
under proper care and control.

Passing from consideration of the general method and aim of
true education, I may point out that the sound and strong
character which it might be expected to form would be well
fortified against some of the most common exciting causes of
insanity — those passions, namely, which often make shipwreck
of the mental health ; for the passions are like the wind which
swells the sail, but sometimes, when it is violent, sinks the ship.
To get rid of an overweening conceit of self, by bringing home
to the individual true conceptions of his humble relations and
subordinate purpose in nature — ^which I take to be one good use of
the overwhelming immensity of the heavens and of the revolving
multitudes of stars — ^would help to moderate and control the
emotional or affective element in his nature, inability to moderate
and control whioh is real slavery ; and to do that would be to
get rid at one stroke of the so-called moral causes of mental
disease. Sorrow for loss of fortune or loss of friend, envies,
hatreds and jealousies, disappointed ambition, the wounds of
exaggerated self-love, anxieties and apprehensions, and similar
heartaches, all of which have their footing in a keen self-feeling,
and gain undue activity from the want of a proper development
of the rational part of the nature, would not then produce that
instability of equilibrium which goes before the overthrow of
the mental balance. What hold could disappointed ambition
have upon him who soberly weighed at their ti-ue value the
common aims of worldly ambition, who perceived the degrada-
tion to be gone througb in order to attain them, who ^ci\^^^ss^^^
the bitterness of achieved success when tYvey ^et^ ^\X»^Tife.^^ «x^^

8

PATHOLOGY OF MIND. [ohAH

who set before liimsolf definitely as Ids true aim in life, for
which he worked definitely, the highest development of which
his intellectual aad moral nature was capable ? His heart
could never be deeply corroded by envy who cared not whether
he did a. great thing or whether somebody else did it, the only
true concern being that it should be done, whose imagination
realised the littleness and the transitoriness of the greateet of
great fames, and whose clearly conceived and ateadfustly pursued
aim it was to reach a passionless serenity of mind. There could
be no overwhelming grief from loss of fortune in him who
appraised at its true value that which fortune can bring, and
that which fortune can never bring ; nor would he be hurt by
the pangs of wounded self-love who saw before him as final end
absorption of self into the all, and had learned and practised as
means thereto the lesson of self-renunciation.

If it be said that this ideal of education is hardly within the
reach of any one, and far beyond the reach of the great mass of
mankind, who woidJ drift from all moral anchorage were they
loosed from the bondage of religious creed, I answer that it is
not really more out of reach than the ideal of Christian life and
I doctrine ; that it is seen to he the goal of the road on which
men are actually travelling so fur as they go forward in evolu-
tion, and not, like the Christiau ideal of doctrine, a point which
is more and more divergent with every step forward which they
make in real life and thought; and finally, that a high ideal to
aim at, so long as it is not absurdly impracticable, is an excellent
means of training, it being the pursuit and not the achievement
which makes the pleasure and profit of labour. Any one who
makes a searching examination of the varieties of human feeling
which are correlated with the different sorts and conditions of
human life may convince himself that it is a baseless opinion
that men would cease to have moral feeling if they ceased to
believe in heaven and hell ; they never can, nor ever do, free
themselves from the ever-present and ever-worting influence of
the social organization of which they are units; being of the
same kind, the kind is in them, and shows itself in commou
feeling. If the social medium be no better than one of thieves
and harlots, there will still be formed, as there always is, a

I.] THE CAUSATIOS AND PREVENTION OF INSANITY. 1«'

particular thiefs conacieDce or harlot's conscience, to violate
which will occasion uneasiness of mind or be thought to bring
ill-luek : the peculiar sort of honour which exists among thieves
and among prostitutes is not derived from any perverted abstract J
feeling of right and wrong, but is developed as a necessary coa-4
dition of their hving together in any sort of social harmony.
It is notorious that a man of honour, so-called, would be more
disgraced among his fellows by hia refusal to pay a gambling
debt than he would be by perpetrating a heartless seduction : the
conventional feeling of the society in which he moves is more
powerful tlian a higher moral feeling. Men are found every-
where to seek that which brings thera fame and reputation, and
to avoid that which brings them shame and dishonour among
their kind, although that which is esteemed may be profoundly
immoral, and that which is despised may be essentially noble.
" Where riches are in credit," says Locke, as though he had
forethought of tlie England of to-day, " knavery and injustice
that produce them are not out of countenance, because, the
state being got, esteem follows it, as ia some countries the crown
ennobles the blood," These examples go to show the en'or of
the opinion that the formation and the power of a moral sense
depend upon a belief in a supernatural power and in a future
Hie ; it is impossible that men should dwell together in unity,
as they do in complex society, witliout the development and
function of moral sense.

It will be the aim of a wise self- training to develop true
thought.a and sound feelings in the mind, and so to coordinate
them in exercise that they shall be available, when required, aa
the best vohtion ; and the means to this end are not observation
and reflection only, but more particularly action. The formation
of character is a slow and gradual process which goes on in
relation with the circumstances of life : what men do habitually
that they will be. It is useless to give advice that runs counter
to the affinities of a character which has been formed by a life-
exercise ; it cannot assimilate it. He who has always done ill
will find it as hard to amend his ways and do well as one who
haa always spoken Eiighsh to speak another language ; as he
unust learn speech by speaking, so he mviRt \.ea.Yu -«(S\,-&a\xv^^

1

I

PATHOLOGY OK MIND. [chap.

doing well. " Cease to do evil^ learii to do well," is the maxim
of a aouud menttl philosophy. The proper coimsfl of a
physician to ouc who consults him concerning what he shall do
to be saved, because of a well-grounded apprehension that hia
mind will give way, would, were it candid and compendious,
oftentimes be — Learn to unlearn. I have often felt despair when
I have been asked anxiously by such a one what books he
should read in onler to fortify his mind against insanity ; for the
hopeless problem presented was how to efface in a day the
growth of a life — nay, perhaps of a line of lives — how to undo a
mental organization. If there has not "been sound discipline to
guide the growth of character through the stages of its gradual
formation, there will be small hope of bending it, when it ia
formed, to new trains of thought and feeling.

Every nature has its particidar tendencies of development
which may be fostered or checked by the circumstances of life,
and which, according aa they are of good or bad kind, and
accoiiiing to the external influences which they meet with, may
minister to his future weal or woe. Too often it happens that
an injudicious training aggravates an inherent fault. Parents
who, having themselves a weak strain in their nature, have
given their children the heritage of a morbid bias of mind, are
very apt unwittingly to foster its unhealthy development ; they
sympathise go essentially vrith it that they do not perceive its
vicious character if they do not actually admire it, as men are
not offended by the bad odours of thoir own bodies, and leave it
to grow unchecked by a wise discipline, or perhaps stimulate it
by the force of a bad example. " He is so spoiled," says the siUy
mother placidly of her child, as though she was saying some-
thing that was creditable to it, or at any rate that was not very
discreditable to her, little thinking of the terrible meaning of
the words, and of the awful calamity which a spoiled life may be.
It may justly be qiiestioned whether the whole system of edu-
cation at the present day does not err on the side of dangerous
indulgence, No doubt such harshness and neglect as might he
likely to repress cruelly a child's feelings, and to drive it to take
refuge in a morbid brooding, or in vague and visionary fancies,
would be a great wrong, but a foolish indulgence, through which

If.] THE CAUSATION AND POEVENTION OF INSANITY.

I^^l

i

^^^K never has infixed in its nature the important lessons of re-
^^^Biinclation and self-control, ia not less pernicioua. Can it be
^^^■rojidered at that persons wliose minds, when they are young,
^^^Bftve never been trained to bear any unwelcome burden, should
^^^Ksak down easily into insanity under the strain of severe trials
^^^m lator life? The aim of early education ought to be soimd
intellectual and moral discipline rather than much learning of
any sort ; to fill a child's mind with details of knowledge in
oi'der to make it a prodigy of learning is likely enough to
prepare for it an early death or an imbecile manliood ; but
nothing can be better than the careful fashioning of its intellect
into a trained instrument by which knowledge may be acquired
readily, and with habits of accuracy, and the formation of a
stable character, which, through the constant practice of self-
denial, obedience, self-control, shall embody those lessons of a
tfpod moral experience which the events of later life will not
1 to enforce tadely.
1 The common system of female education, which ia now
lling fast to pieces, was ill adapted to store the mind with
"iiseful knowledge and to train up a strong character ; had it
been designed specially to heighten emotional sensibility and to
weaken reason it could hardly have been mora fitted to produce
that effect. Its whole tendency has been to increase that predo-
minance of the affective life in vroman which she owes mainly to
her sexual constitution, and the intellectual and moral outcome
of which is seen in judgment by feelings, in intuitive per-
ceptions rather than rational appreciation, and in conduct
dictated by impulse rather than by deliberate will. Hitherto
ehe has been trained to no outlook but marriage, and to culti-
vate only such accomplishments as might be moat usefid to
attain that end; through generations her chai'acter has been so
informed ; when therefore the end ia missed all else is missed.
Disappointed of marriage, to which her whole nature tends, there
baa been no outlet of action in which the energies of her feel-
ings might be dischai^ed vicariously, and she is ill fitted to
bear the stress of disappointment with the long train of conse-
CLUences, physical and moral, wliich it draws after it.
L Undoubtedly cases do occur fiam time Sa "Civne 0*1. \»s.\-v\.'i^

Wl9i PATIIOLOGY OF MIND. [i

^^1' derangement in unmarried women, especially of tlie upper and

^H middle classes which appear to have been caused mainly by the

^^B frustration of this fundamental instinct of their being, aud by

^^■'the want, in the present social system, of suitable spheres of

^^H activity in which its energy might have vicarious expression,

^^P Between the instinctive impulses with the emotional feelings

that are connected with them and the conventional rules of

society which prescribe the strictly modest suppression of any

display of them, a hard struggle is not unfrequently maintained.

The keen self-feelings and passionate longings, heightened to a

morbid pitch hy continual brooding, perhaps take a religious

guise as the only channel through which they can be expressed

freely without impropriety ; and the occasional result is a form

of mental derangement marked by a strange mixture of erotic

feelings and religious visions ox delusions. AVith the improve-

■ ment of female education and with the now openings for female
labour we may expect the predominance of the affective life to
be somewhat lessened, the resources for work to be systematically
used, and higher aims than frivolous amusements to be pursued ;
and the reaction of a dilferent mode of life upon female educa-
tion and upon female nature cannot fail to be considerable,

• Thus much concerning education in its bearing on the pro-
duction of insanity. If the foregoing opinions he correct, it ia
clear that any increase of the disease which may be taking place
now is no proof that education will always fail to check such
increase ; it is an ailment only that a method of education
which is faulty at its foundation does not help to prevent insanity,

I if it does not actually help to produce it. It is still in the
working of a sound education and training that we expect not
only to neutralize a predisposition to mental derangement in
the individual, but to counteract any tendency to an increase
ttiereof in the community which may spring from the evils
accompanying the benefits of civilisation ; the external advan-
tages of which may naturally lead in the end to a belter in-
ternal culture, so furnishing in its higher stages a remedy for
some of the mischief which it produces in its earlier stages.
^^ Sae. — It has been a disputed qiiestion, which is not yet settled. ,^^
^L definitely, whether more men than women go mad. E(-quii^JS

S_] THE CAUSATION AND PBEVENTION OF INSANITY.

E

^^^Btoiigltt that men more often went irrong, but lie omitted in his
^^^blculatioDs to take sufBcieut account of the preponderance of
^^^Rh)meD in the population, that pFe)K)nJe ranee being greatest
\ietween the very ages of twenty and forty, when insanity most
often occurs, and he was also led astray by drawing his con-
clusions &om a comparison of the existing cases instead of the
^^MiKcurrlng cases in the two sexes. It is worthy of remark that
^^nttioie malo than female children are horn : in England during
^^ton years {from 1857 to 186C) the proportion of male children
bom ahve to females was about 1045 to 100 ; in France
during 44 years it was i06'2 to 100; in Russia the average
proportion was 108-9 to 100; among Jews it is higher still;
but inasmuch as more males are stillborn than females, as more
die early, especially during the first year of life, and as more
perish by accident or emigrate, it comes to pass in the end that
females preponderate in old settled countries. Out of a popu-
lation of 24,854,397 in England and Wales there were 12,097.547
males, and 12,756,850 females, and of these on January 1st, 1878,
31,024 males and 37,514 females were known to he insane. The
ratio of male lunatics to the population was 2564 per lO.OOf
that of female lunatics 29'40 ; and pretty nearly the same rela-'-!
tion will be found to hold for the corresponding ratios of the
last eighteen yeare.^ We may take it then that the excess of
female lunatics is greater than is accounted for by the excess of
the female population, and that some other cause or causes must
be sought for to explain it. In matter of fact the number of
men actually admitted into asylums, which may be taken
roughly but fairly to represent the number of occurring eases
among men, is found, when the records of asylums are ex-
amined, to be considerably above that of female admissions.
One cause of the preponderance of female lunatics certainly is
the much greater proportionate mortality among male lunatics,
tliis being due mainly to the fatality of a single disease, namely,
-i^neral paralysis, which is almost confined to men, seldom

' Among private lunatica the ratio ia, and alwnys has beeD, higher for

JUies, being 3-45 against 2-76 for females per 10,000. One reason pro-

nb]y is that it is eiLsier to kaep inscne fcinales at home ttiuong uIubma

B paupers.

^

PATHOLOGY OF MISD. [ce

attacluQg women ; and to this main cause may be added another

subsidiary cause, namely, the greater proportion of relapses which
has been observed to tate place in women. For these reasons
it is that women accumulate in asylums more than men ; and
this accumulation, taken in connection with the excess of
females in the population, is probably enough to account for tha

■ excess of existing female insanity.
Dr. Thurnam concluded at the end of his patient inquiries
that men were more liable to mental derangement tlian women ;
and tliat is the general belief now. Granting it to be true, it
must not therefore be supposed that it is because of anything
in the constitution of men which renders them more liable to
such derangement ; on tlie contrary, there ai-e obviously dis-
turbing conditions pecuHar to the female constitution wliich are
more fitted to be occasions of mental disorder — to wit, the con-
stitutional change at puberty, pregnancy, child-bearing and its
sequences, and the climacteric change, with each one of which
we con connect a definite variety of insanity. The true reason
no doubt wliy more men go mad is that they are exposed in the
strugges of life to more numerons, varied, and powerful causes
of mental disturbance. The strain of work for competence or
wealth, the anxieties and apprehensions of business, the burden
of family responsibilities weigh more heavily as a rule upon
men who are the bread-winners than upon women ; intemperance
^^ again, which is one of the most active causes of insanity, is a
^^L much more active cause among men than among women ; and
^^P there are other excesses, especially sexual excesses, to wliich
^M^ they are more proue and which do them more hurt than they
do women. In fact these three classes of effective causes are
enough to outweigh the greater tendency to mental disorder
which lies in the nature and functions of the female organization,
as well as the neiTons instability which women acquire in tlie
present social system by reason of defective education, aimless
lives, frivolous amusements, and the lack of resources of work.
The right conclusion at the end of the whole matter would
seem to be that while there is no very sensible and certain

difference between the proportions of men and women who

^L become insitne, as the causes actually operate, men are cxpos^^B

IV.] THE CAUSATION AND PEEVENTION OF INSANITY. 167

to more numerous and powerful eitrinsic causes, and women,
by virtue of their sexual organization, to more numerous and
powerful intrinsic occasions, of insanity. In proportion as
women invade those departments of work which men have
hitherto appropriated they will expose themselves more and
more to those extrinsic causes of derangement, and it is a grave
question whether they will not find themselves overborne by
the joint action of the weight from without and the weakness
within.

Age. — I have pointed out already that the relative activity of
different organs and tissues at diflferent ages plays some part in
the occurrence of particular diseases at those ages, and that
it is especially so when there is an organic predisposition to
disease. It is not surprising then that mental derangement is
uncommon before puberty ; for up to that time the part of the
nervous system which ministers to muscular action is in active
function, and the consequence is that epilepsy is the most
common nervous disease. Still all forms of insanity except
general paralysis do occur even so early in life. Most often it
has then the character of mental defect, and may be classed
under idiocy or imbecility ; the mental organization being in-
complete, its disorders bear witness to its undeveloped state.
Even those cases which are described as examples of mania,
because of great excitement and activity of mind and body,
might in most instances not unfitly be classed as cases of
idiocy or imbecility with maniacal excitement. At first sight
it is surprising enough that striking examples of moral insanity
should be met with in quite young children ; but it is certain
that instances do occur not of true moral imbecility only, where
the unfortunate beings, who are perhaps not of quite nonnal
intelligence, have been born without the least capacity of moral
feeling, but instances also of active display of all sorts of
immoral impulses with acute intelligence of the purely selfish
and cunning type. Between the ages of sixteen and twenty-
five insanity is more frequent, because of the great revolution
which then takes place in body and mind, of the new passions
which spring up, and of the fresh start in mental development
which is made; but it is most frequent ot aH ^L\)lra\^^i^^.^^^^^s^^

168 PATHOLOGY OF MIND. [chap.

of full mental and bodily development — from twenty-five to
forty-five years of age — when the functions are most active and
when there is the widest exposure to causes of disorder. The
internal revolution which takes place in women at the climac-
teric period leads to many outbreaks of melancholic derangement
between forty and fifty ; and it has been thought that a sort of
climacteric change occurs in men also, usually between fifty and
sixty, when insanity sometimes shows itself. In old age senile
dementia is the most common form of derangement ; it is the
pathological term of the natural decay of mind which occurs
when nature —

" As it grows again towards earth,
Is fasliioned for the journey, dull and heavy."

Occupation and Condition in Life, — Whether one profession,
trade, or pursuit more than another favours the occurrence of
insanity is not really so much a question of the effect of the
particular pursuit as of the habits of those who follow it and of
the spirit in which they follow it. Among the lower classes of
society it is for the most part a question of sobriety and tem-
perance against intemperance and riotous living. In the classes
that are above the lower, when a man sets before himself as
his aim in life riches or social position, not for any good use of
what he gets by his toil and cares and heartburnings, but as
an end in itself, let his business be what it will, he is pursuing
a not very worthy end, and will be likely to do so in an in-
temperate way, if not by actually unworthy means. If the
social system be one in which riches are held in great esteem,
and his passionate ambition is to get rich, he will not boggle
much at the knavery which helps him to his end, and which
will be overlooked by such a society in the admiration which
it bestows upon success. Even when a man has made success
or reputation in business the exclusive aim of his life, not out
of a mere desire to become rich, but out of an eager energy
and honest love of doing his work well ; when he has by long
concentration of desire and work upon it grown so completely to
it as to make it the entire current of his life, that to which all his
thoughts^ feelings, and actions turn habitually, and in which they

KS^H

I,] THE CAUSATION AND PKEVKNTION OF IKtL^NITY. II

are engrossed — other interests being as it were little and acci-
dental eddies that escapo for a abort timo only thy attraction of
the main stream — lie is ill fortified hy mental culture against
the shock when hope is shattered, his pride of opinion brought
low, and the fabric which he has raised with all the eagerness
and energy of an intense egoism levelled to the ground by a
crushing blow of misfortune. Nay, the belief only that such a
catastrophe is threatened may he enough to overthrow him ; for
if nine out of ten parts of his being and energies are absorbed
in the successful prosecution of his work, aud that has had a
severe check, where is an adequate recuperative and distracting
force to come from I He is not unlikely to sink into an agitated
apprehension, and from that state to lapse into dcspairing^^H
melancholy. ^^H

It was a common notion at one time that governesses were^^H
victims of insanity out of all proportion to their numbers, and i

much sympathy was spent upon them in consequence. But the
opinion was not well founded. It originated in the observation
that a great number of governesses were received into Eetldehem
Hospital — as many as 110 in ten years; the reason of which
was not that so many more of them than of other classes went
mad, but that they were just the persons who fulfilled best the
conditions of charitable admission into that hospital, being poor
enough to be unable to pay for care and treatment in private
asylums, but yet not poor enough to be paupers and suitable ^h
for admission into county asylums. ^^H

If it be true, as is said, that persons who work with the head/^^H
are more liable, on the whole, to mental disease than those who ^|
work with the hand, and that they are less liliely to recover when
they have had an attack, we may easily understand the reason
to be that a more complex and delicate mental organization, with
it-s greater variety and activity of function, will furnish more
frequent occasions of disorder, and that the disorder will do
greater hurt to the finer and more delicate instrument. But it
would probably he a fuller statement of the truth to supplement
it hy adding that those who work with the heart are more likely
^ ,. to fall insane than either headwoikers or handworkers ; for the. ^^
^B^uses of the derangement are to be fowud tio\. so -nw^^ ^si "Oo^^H

^Pto

^^E

PATHOLOGY OF JIIXD. [uiiF^

strain of the intellectual work as in tlio passion and feeling
whieli are put into it, and which ai-e the teal wearing force. It
is not in fact the nature of the occupation, hut the temperament
of the individual, which determines mainly what emotional wear
and tear there shall he ; one person may fret and consume his
lieart with anxiety in the small cares of a petty husiness, while
another shall conduct the complex affairs of a mighty nation
with unconcern of feeling.

All privileged or so-called aristocratic classes have in Uieir
privileges the conducive elements of corruption and decay, aoil
degeneracy of one sort or another is likely, sooner or later, to.j
appear and spread among them, lioubtless it is a good anct^
praiseworthy thing to reward eminent service to the state by
conferring honours and privileges upon the deserving individual ;
hut that such privileges should descend as a heritage to his pos-
terity for ever, whatever their qualitj', is a custom which, were it,
proposed to he established now for the first time, would pi
bably be encountered with incredulous amazement. The mattatj
is of course worse when the honour is conferred for servii
which mark the dishonour of those who have rendered them.

A nation which wishes well to itself will aim to unite
people in the bond of unity, brotherhood, and equality, not to
divide them into privileged social castes and orders. It is im-
possible to say positively what degree of truth there is in the
often made statement that insanity is of disproportionate fre-
quency among the so-called aristocracy of this and other countries.
If it he true, one reason may be too close and too frequent inter-
marriages such as are likely to occur where clanship prevails,
and do occur certainly in royal families. In this country, how-
ever, we observe powerful causes silently working to break down
the exclusive barriers of caste and to widen the area of
tion for breeding ; a wealthy banker, brewer, gin-distiller, con-
tractor, manufacturer, or person of that kind of consequeni
who has gained all the wealth which his heart desires, is com-
monly an unsatisfied man until lie has wriggled into a higher
social position, and, more blessed still, has allied himself or his
family by marriage to some titled family ; and the younger sons
,nd the daughters of titled families who, owing to the law of

>os-

eit. ^_

to '^

ec-. ^^
im-^^l

TUB CADSATION AND PliEVENTlON OF INSANITY. 171

etitail and t!ie privileges of primogeniture, are needy in proportion
to their pretensions, gladly seelt by marriage into wealthy oom-
niercial families the meaiis to support their social position. It
may be doubted whelher such marriages commouly turn out
well so fat as health and vigour of oifspring are concerned.
The reasons I take to be these : first, that men who have made
it the sole work of their lives to get money, and having got it
have had no higher aim than to use it to gratify a contemptible
social passion, are not such as are likely to breed sound moral
constitutions in their children; and, secondly, that the needy
memhers of titled families who sell themselves for subsistence
instead of earning it by honest labour are as little likely to be
fitted to breed well.

There seems to be no doubt that, other things being equal,
insanity is more frequent among unmarried than among married
persons : a fact of which it is not difficult for an ingenioua
person to invent several theoretical explanations.

One consideration more it wili be proper to take notice of
before leaving this subject, Over- population, which prevails ia
some civilised countries, is the cause of numeraus ills to man-
kind, amongst which we may probably reckon an increase of
mental disorders. In the eager and active stru^le for existence
whicli goes on where the claimants are many and the supplies
are limited, and where the competition therefore is fierce, the
weakest must needs sufler, and some of them, oppressed by
poverty, fi'ctted by constant cares, and overwhelmed by anxieties,
will break down into madness. Moreover the overcrowded and
unhealthy condition of dwelling-houses which over-population
occasions cannot fail, in conjunction with insuflicient nourish-
ment, to lead to deterioration of the health of the community,
and so to predispose to disease of different sorts. Not fevers
only and epidemic diseases, but scrofula, phthisis, and other
constitutional states marked by general deterioration of nutrition,
are engendered and transmitted as evil heritage from generation

[eneration.
Tit is not that the child inherits necessarily the particular
Jisease from wliicli the parent suffered, but it inherits ^rob^.t.\:5
b constitution in which there is an iii\vCTeiv^- a,'e'L\'w\&.% \.o

1

er
n,

1

w

PATHOLOGY OF MIND.

kind of morbid degeneration, or wliiuli is destitute of
reserve force necessary to meet successfully siicli extraordinni
strains as the trying occasions of life cannot fail to exact soiue^
timesj Disease not being, as it was so long thought to be, a
specific morbid entity which, like some evil spirit, takes hostile
possession of the body or of a particular part of it, and must
"be expelled by some Bpecific drug, but a state of greater or less
d^eneration from healthy life iti an organism whose different
parts constitute a complex anJ hannonioua whole, it is plain
that a disease of one part of the body will not only affect
the whole sympathetically at the time, but may well lead to a
more general infirmity of constitution in the next generation.
Whatever wealiens tlie organism of the mother may certainly
be a cause of idiocy of tfia offspring, especially when the debili-
tating cause acts during pregnancy. No doubt the special
morbid outcomes of the inborn infirmity will be determined
in some measure by tlie external conditions of life : we oiiglit
always to take into account the unthout as well as the within.
If a person has inherited a generally feeble constitution, and if
the circumstances of his life chance to be such as put a great
strain upon his brain and nervous sj'stem, he is not unlikely
to suffer from some form of mental or nervous disorder : tlie
man, for example, who has responsibilities to which he feels him-
self unequal, or is harassed by pecuniary anxieties or by domestic
troubles, or the woman whose life a worthless husband makes a
daily round of dreary suffering, will show the general want of
constitutional reserve force by the derangement of the special
organ on which the strain falls.

It is natural to feel sympathy with madmen when one sees
how the fine and sensitive nature of one has broken down
under the wearing grind of the coarse and rude experiences of
life; how the thoughts of another have oftentimes deviated
from the beaten track into brilliant flashes of quick insight ;
how eagerly animated with the spirit of enthusiasm a third has
shown himself; but while sympathizing with their sufferings
and their fate, we must still confess that their failure meant
weakness, and that they succumbed because it was right they
[jdionld succumb. Albeit it is a sad thing to see a person fall

17.] THE CAUSATION AND PREVENTION OF INSANITY. 173

from a height and break his neck, it would perhaps be a sadder
thing for the law of gravitation to be suspended for a moment
in order to save his neck, and for the universe to go to wreck.
It is sad to contemplate the spectacle of Lear, driven mad by
his daughters' ingratitude, and shrieking to the pitiless heavens
in shrill senile lamentations, but it would be a sadder thing
in the end if so little insight into character, so little prudence,
and so little self-control as he showed were to issue in a
prosperous and peaceable old aga The aim of man's develop-
ment being to bring himself gradually into more and more
special and complex relations with his social and physical
environment, by intelligent observation of the laws which
govern these relations and by corresponding adaptations on his
part, he must fail if he is unequal to the struggle imposed upon
him, whether it be from inherited weakness or from any
other cause, just as a tender plant must wither and die in a
poor soil where hardier plants compete with it. Nay, he may
fail if he is not weak, but only unfortunate ; for as one seed
may be as sound and vigorous as another seed and yet perishes
if it fall upon barren ground, so may a fairly strong man un-
haply chance upon evil circumstances against which he con-
tends in vain. The benevolent observer could have wished him
to have falleu upon better times and among kinder surround-
ings, but it is useless to repine ; he has passed away as an abortive
being, and must be counted one of those countless germs which
nature sheds in lavish profusion, and never brings to develop-
ment.

In a certain sense then one may take comfort and be glad
intellectually that failures should fail ; for if the weak were not
defeated in the struggle for existence, it would be because the
strong, holding back to the slower pace of their infirmities, used
not their strength, and so robbed the world of the right which
it has to, and the advantage which it would get from, the full
use of their superior powers. An increase of mental disease in
a country means not necessarily the degeneracy of the people ;
the capability of development being the capability of degenera-
tion, like height and depth opposite and equal, it is not Vwl^ \si
understand that when progress is going on aeXivN^^ ^^V-t<^^^6^«^

174 PATHOLOGY OF MIND. [chap. nr.

action may be going on side by side with it, that madness may
be a waste of the individual to the profit of the race — dead
reason thrown off by vigorous mental growth — a seeming evil
which is truly a phase in the working out of higher good.
Man rises in humanization at the cost of his kind, mouutinir
upwards over the ruins of the races that have successively come
and gone before him, and it would be as absurd to lament the
disappearance of the once mighty nations whose places now
know them no more as to lament the mental degeneracy which
correlates mental progress.

Thus much concerning the remote or predisposing causes of
insanity. It remains now to set forth the direct or proximate
causes of defect or derangement of the supreme centres of intel-
ligence. In doing this it will be most convenient, and in the
end most scientific, to group them as the causes of disorder of
the sensori-motor and spinal centres have been grouped^ — ^in
other words, to treat of the causation of insanity from a patho-
logical point of view.

^ The Physiology of Mind,

CHAPTER V,

THE CAUSATION AND PREVENTION OE INSANITY {GoiltimLed).

B. Patlwlogical.

The Proximate Causes of Disorder of the Ideational Nervous

Centres.

In proceeding to consider those causes or intrinsic conditions
which, more immediately going before mental disorder, may bo
called proximate, I shall first treat briefly of the actual defects,
observed or inferred, of structure and of development in the in-
tellectorium commune. I treat of them because it is necessary
to give a general idea of what is known concerning them now,
and I treat of them briefly only, because what is known yet
is but a hint, as it were, of what remains to be discovered
hereafter.

1. Original Differences in the Constitution of the Supreme
Nervous Centres, — Undoubtedly there exist great natural difier-
ences between diflerent people in respect of the development of
their cerebral convolutions. In the lower races of men these are
visibly less complex and more symmetrical than in the higher
races ; the anatomical differences going along with differences in
intellectual and moral capacity. If a Bushman, with his inferior
type of brain, were placed in the complex circumstances of civil-
ised life, though he might represent a high grade of development
of his lower type, to all intents and purposes he would be, as
Gratiolet allows, an idiot, and would, unless otherwise cared for,
inevitably perish in the severe competition iot exAS»\.^\i'^^ ^<et^

176 PATHOLOGY OF MIND. [chap.

a person bom amongst civilised people with a brain of no higher
order than the natural brain of the Bushman, in consequence
of some arrest of its natural development, it is plain that he
would be more or less of an idiot ; a higher type of brain,
arrested by morbid causes at a low grade of development, is
brought to the level of a lower type of brain which has reached
its full development As Von Baer long ago pointed out, the
actual position of a particular animal in the scale of life is
determined, not by the type alone, nor by the grade of develop-
ment alone, but by the product of the type and the grade of
development.

The principal varieties of defective brain met with cannot
be described in detail here ; sufiBce it to say that all sorts and
conditions of incomplete growth and development have been
observed in different instances.

There are idiots of the microcephalic type, in whom an arrest
of cerebral development has taken place, and a palpably defec-
tive brain is met with in consequence. Malacarne was at the
pains carefully to count the laminae of the cerebellum in idiots
and in men of intelligence, and he found them to be less
numerous in the former than in the latter. Now these laminae
are less numerous in the chimpanzee and the orang than in
man, and still less numerous in other monkeys ; so far, there-
fore, there is an approximation in some idiots to the simian
type of brain. Mr. Paget has described an idiot's brain in
which there had been a complete arrest of development at the
fifth month of foetal life: there were no posterior lobes, the
cerebellum being only half covered by the cerebral hemispheres,
as is the case normally in many of the lower animals. Dr. Shut-
tleworth found in the microcephalic brain of an imbecile that
although the frontal and parietal lobes were fairly developed
the temporo-sphenoidal lobes were small and deficient in front, and
their convolutions and fissures incompletely marked; the occipital
lobes were quite rudimentary, exhibiting no fissures and convolu-
tions, so that the greater part of the cerebellum was uncovered.^
Gratiolet found in the brain of a microcephalic idiot, aged
seven, the under surface of the anterior lobes much hollowed,

^ Journal of Mental Science^ October, 1878,

THE CAUSATION AND PREVENTION OF INFANlTi'. 171

witli great convexity of tba orliital arches, as is the rule ii
the monkey.^

Mr. Marshall has carefully examined, and described ini"
an elaborate paper, the brains of two idiots of European
descent : the convolutions were fewer in number than in the
apes, individually less complex, broader, and smoother-
this respect," he observes, " the idiots' brains are even morg
simple than the brain of the gibbon, and approach that of thftj
baboon (CynocephaUts) and sapajon (Ateles)." ^ Tiiough he
agrees with other observers that the condition of the cerehra in
the idiots is neither the result of atrophy nor of a mere arrest
of growth, but consists essentially in an imperfect evolution of
the cerebral hemispheres or their parts, dependent on an arrest
of development, he points out the strong grounds there are fOJ
inferring that, after the cessation of evolutional changes, the'
cerebra esperienca an increase of size generally, or a mere
growth of their several parts. Consequently the cerebra are
much larger than fcetal cerebra in which the convolutioual
development is at a similar stage ; the individual convohitions
themselves, though the same in number, are necessarily broader
and deeper ; and the result might conceivably he a brain of fair
size wliich was still imperfectly developed. Many more in-
stances have been recorded of idiots' brains in which there was
a defect of convolutions when compared with a normal Cau-
casian brain ; the principal convolutions being more simple and
symmetrical, and the secondary ones sometimes wanting. What-
ever its defects, however, an idiot's bi-ain never resembles a
monkey's exactly, any more than an idiot ever reeemblea exactly
a monkey in mind : it is not a complex mechanism brought to
the condition of a simpler mechanism, but a complex mechanism
imperfectly constructed, and less fit for its purposes therefore
than the simpler mechanism.

Not only is the brain-we^ht in microcephalous idiocy very'
low absolutely, as the instructive tables of Dr. Thurnam show,
flit the relative amount of brain to body is " extraoidinarily "
Uminished. Thus in the two idiots described by Mr, Marshall

^ Anntomis Oomrmrie du. Syn&nis Neroeax.
2 Pkilomjihical TraatcKtiom, (oc, cit.

4
1

TATIIOLOGV OF MIXD. [.

the proportion of Lrain to body was only as one to 140 in
the female, and as one to sixty-seven in the male, the normal
proportions being as one to thirty-three and us one to fourteen
respectively.

It is not necessary that I quote more authorities to prove
that small-headed idiots have small brains, and sometimea
even fewer and more simple convolutions than the chim-
panzee and the orang ; that man made a morbid kind by an
arrest of development may be brought to a lower level than
that of his nearest of kin among animals.* A strict examination
of the stories of so-called wild men, as of Peter the AVild Boy and
of the young savage of Aveyron, has proved that these were really
cases of defective organization — pathological specimens.' The

I interest of tbera lies in this, that as idiots show a nide re-
L sometimes towai-ds a lower type of brain wliich is

\ natural to a lower animal, so in their habits and instincts fhey
"mes exhibit evidence of a revei'sioa to the fundamental

\ instincts of auimal nature.

In some idiots and imbeciles, especially those of the Cretin

I type, where the moi'bid condition is endemic, the defect seems
to depend on certain morbid changes which affect primarily the

I skull rather than the brain. Injurious influences, aflecting the

I general processes of the bodily nutrition, prevent the normal

k growth of the bones, which undergo a premature ossification of
their sutures; the consequence of wliich is that the general
expansion of the skull, which should take place as the
brain grows, is prevented, or that a narrowing of the skull is

t produced at the part where this happens. Secondary wide
interference with the development of other parts of the skuU
and compensating enlargements in other directions follow the
primary evil when it is partial, and give rise to cranial del'onni-
;
;

Absenpe or defect of (he corpus calloaum has been poraetiiiiea met willi
after death, but Beliiom ; otiior cerebral deticiencies will commonly coexist
with it ; and in moRt of the cases of this sort there was idiocy or HOtiie
degree of mental weaI^ncsa during life. Dr. Julius Sander has collected
ten cases, which appear to be oil the canes hitherto recorded of this defect,
nod desoribed them in Griesinger'a Archiv Jur Pifychiatne und Neroai-
iran^Aeiffn, b. L I8GS.

* Observatioju on the Derapffed ManifeslaHmtg of the Mind. By J.
^o^zLeiin, M.D. Also LectJires on Man, By W. Lawrence, F.K.S.

1

^Kiii

Ir.] THE CAUSATION AND PfiEVENTION OP INSANITY.

ties of varioua kinds. It is coinmou to ofiaerve in iiubecila
children, especially in such as are of a. scrofulotis tempera-
ment and in those who have an insane inheritance, a very
narrow and deeply arclied palate, which is described as saddle-
shaped ; it is a deformity which seems to he connected with a
defective growth of the bonea at the hase of the skull ; and
^ ■when it exists without actual imbecilitj- it usually goes along
;with only a slender understanding. Of necessity the natural
growth of the brain is hindered by those morbid changes ; and
it is no wonder that the deformed head is accompanied with a
torpid, apathetic character and with great mental deficiency.
Ilowever, the defects of brain and bone may be concomitant
effects. As the evil changes are commonly not manifest until
a year or mora after hirth, am objection might well be made to
the description of them as m-iginal defects ; hut whatever the
real nature of the deterioration of nutrition which is at the
bottom of the mischief, whether it be of malarious or scrofulous
nature, it admits of no question that it acts upwi the child
through the mother perniciously, and predetermines its defect.

An arrest of the development of the brain occurring soon after
bu-th may give rise to idiocy juat as certainly as an arrest which
has taken place some time before hirth. Specious objection
might be made to the description of the defect as original ; but
when we reflect that the important development of the bmin as
the supreme oi^n of the conscious life, as subserving the mental
organization, really takes place after birth, we may admit tliat
a defect which frustrates development is practicidly original,
albeit not strictly congenital. There are not a few idiots in
whom the brain and body appear to be well formed, while the
mental development remains at the lowest stage. Epilepsy
ia oftentimes such a cause of idiocy, but it ts not possible in
.fill cases to assign a definite cause of the arrest.

In some instances of apparently uoi'mal brains with deficient
intellect, it is found on examination that the ventricles are
more or less dilated and contain more than their normal quan-
tity of serous fluid ; intermediate conditions, indeed, are met
,with between the normal state in this respect and the vastly

lated ventricles and expanded cerebraV a\:ioa^'ftRa lA S\m».

w

I exbre

PATHOLOGY OF MIN'D. [rB

I

I

mi

extremely hydrocephalic brain. lu other instances where the
braiii looks normal to the naked eye, or is actually hypertrophied,
microscopic examination has ehown that its normal or ahnonnal

1e is owing not to the natural quantity or to a natural increase
of its proper elements — namely, the neri^e-eella and fihrea, —
but to an abnormal increase of the connective substance, entail-
ing perhaps eventual atrophy of them and their capillaries. In
other instances tlie pathologist cannot find the hidden defect in
the seemingly perfect organ ; nor need we wonder much at
that when we reflect that most important intimate physical and
chemical changes may exist without being detected by any
means of research that we are yet in possession of. There is
nothing indeed to prevent whole territories of cells in the cere-
bral convolutious being wanting without the pathologist being
able to find it out. Lastly, the fault may lie in the distribution,
quality, and activity of the blood circulating in the brain ; the
active supply of good blood which is necessary to full and quick
intelligence being prevented, either by a defective quality of the
blood occurring as a part of the general defective nutrition, or
by a feeble or defective heart, which is not very uncommon
in idiocy.

■ Other idiotic creatures have the development of body as well
as mind arrested. The extremest cases of the kind are those in
which there has been a complete cessation of growth at an early
I period of childhood, without any observable deformity. Dancel

has recorded Uie case of a girl, aged twenty-four, who had deve-
loped normally up to the age of three and a half years, after
» which no further growth took place until she reached eighteen
and a half years, her bodily and mental condition being that of
a child of three and a half years old. At twenty-one she in-
creased a little more in size, and then remained unchanged for
the rest of life, Baillarger exhibited, in May, 1857, to the French
Academy of Medicine, a young woman aged twenty-seven, who

I had only the intelligence and inclinations of a child four years
old, and who was about three feet high, I have seen a some-
what similar instance in an idiot man. Such extreme cases are
well suited to excite surprise and curiosity ; they are, however,
only gi'oss results of a deficiency in developmental power which

r.J THE CADSATIOS AND PI!EVENT10X OF INSANITY.

W

^^^K often met with in a less degree, and which is actually wit-
^^^feessed in every degree. The truth is, that every elemeut of
^^^piie body shares usually in the defective vitality of idiocy. In
any large idiot asylum idiots are to be found who, without any
particular deformity, without any observable disease or defective
development of brain, are generally sluggish both in bodily and
mental development ; their size is small ; their sexual develop-
ment takes place late in life, or perhaps does not take place
at all; their circulation is languid, and their sensibilities are

I extremely dull ; their movements are not brisk, but feeble and
^»eavy, and sometimes partially paralyzed ; their skin gives off
^ offensive odour; their teeth are carious and soon drop out,
tn mental capacity they are in advance of the true idiots,
pr they can learn a little, are capable of remembering, and
perhaps imitate cleverly : some of them constitute the " show-
cases " of the idiot asylum wiien they are in it ; and, when
they are not, they may become diiiicult cases for medico-legal
inquiry, if, in consequence of the strength of their passions
and of their deficiency of moral power, they do some deed of
criminal violence, as tljey are more likely to do after puberty
than before it. All the concern that we have with them here is to
draw from them the certain conclusion that there may, by reason
of unknown conditions affecting nutrition, be every degree of
imperfect development of mind and body down to actual incapa-
city to develop at all ; wherefore imbecility cannot be measured
by any constant standard, but must always be a matter of degree.
The causes of the defective cerebral development which is the
physical condition of idiocy are often traceable to parents. Fre-
quent intermarriage in famihes seems in some cases to lead to
a degeneration which manifests itself in individuals by deaf-
mutism, albinoism, and idiocy.^ Parental intemperance and
excess, according to Dr. Howe, hold high places as causes of
convulsions, idiocy, and imbecility in children ; out of 300 idiots

I4ji the State of Massachusetts, whose histories were investigated by
ibiin, as many as 145 were the offspring of intemperate parents.*
t

"On Consnngruineoua Marrinfe'cs." By Artliiir Mitcbell, M,D.— fi/iK-
rgh Medical Jottmal, 1865.
' flgwrt on the Cauiee of Idiocy in the State <if MuSBudmstUs,

J

182 PATHOLOGY OF MIND.

[chap.

P.iit otliiT inquirers wlio have lx!cn at the pains to critically test
his statistics have not been ahle to accept so high a ppoportioa
It is not douhted that tlie parent who makes himself a temporary
hmatic or idiot by his degnulin;; vice does sometimes propagate
his kind in procreation, and entail on his children the curse of a
hopeless fate, ilany remarkable instances have been recorded
by different authors. Guislain mentions a family of maniacs
born of a woman who was drunk every day. In the Mechanics'
Institution at Manchester are the casts of the small heads of
seven itiiots ; their father was a desperate drunkard, and as he
kept a public-house, he was almost always drunk, or had just
been so, or was about to become so. Nothing particular was
known of the habits of his wife. Tliey had eight children the
lirst seven of whom, who were the idiots in question, were bom
while the father was under the influence of his drunkeu habita
Having dissipated his property lie had no longer the means to
get dnink, and the last child, a daugliter, which was bom while
he was sober from compulsion, was perfectly sane, and was
married in due course.^ " A man," says Marcd, " who had several
times, in consequence of excessive drinking, had symptoms of
insanity, married twice : with his first wife he had sixteen child-
ren, fifteen of whom died within a year of convulsions; the
survivor is epileptic. With his second wife he had ei<»ht
children ; seven have fiiUen victims to convulsions, and the
eighth is scrofulous." * The natural term of insanity proceeding
unchecked through generations is, as Morel has shown, sterile
idiocy. When man frustrates the purposes of his being, and
selfishly ignores the laws of hereditary transmission, nature takes
the matter out of his hands and puts a stop to the propaimtion
of degeneracy. Great fright or other mental agitation affecting
the mother during gestation, or irregularities and excesses on
her part, and injury to the child's head during parturition, may
occasion a congenital mental defect in it. But many of the causes
of idiocy operate after birth up to the third or fourth year.
They are epilepsy, the acute exanthemata, perhaps syphilis, and
certainly starvation, dirt, and overcrowding.

* Dr. Noble, Ehmmta of Psychological Medicine,

2 Traite Pratique des Maladies Mentales. Dr. L. V. Mare6 1862

v.] THE CAUSATION AND PREVENTION OF INSANITY. 183

When there are no such signs of degeneracy as warrant the
suspicion of idiocy or imbecility, there is still large room for
physical causes of psychical defect which we cannot detect. The
sensibility of nervous structure, whereby an impression made
at one point is almost instantaneously felt at any distance, is
the consequence of delicate, active, but occult movements of
its molecules, which, like thermal oscillations or undulations of
light, or the intimate molecular conditions of colour, belong to
that inner life of nature that is still impenetrable to our most
delicate means of investigation, still inaccessible to our most
subtile inquiries. Who can declare the nature of those hidden
molecular activities which are the direct causes of our difiFerent
tastes and smells ? Could we but learn what these intimate
operations essentially are, we might perhaps attain to a know-
ledge of the intimate constitution of bodies which we hardly
dream of now ; indeed it seems not impossible that in the scien-
tific cultivation and development of the senses of taste and
smell, as the eye, the ear, and the touch have been cultivated
and developed, we may ultimately gain some means of insight
into the inner recesses of nature.

A second reason why there may be numerous and serious
defects of nervous structure which cannot yet be discovered
is based upon the infinitely complex and exquisitely delicate
structure of the cortical layers of the hemispheres. It must
be confessed that many physical paths of nervous function in
the supreme centres may be actually obliterated without our
being any the wiser, for it was only yesterday, so to speak,
that men succeeded, after infinite patient research, in demon-
strating a direct communication between the different nerve-
cells, and between nerve-fibres and cells. The obliteration
of such a physical communication in the supreme centres
might plainly render impossible a certain association of ideas,
or the transference of the activity of the idea to an out-
going nerve-fibre — a particular function and expression of
mind. The convolutions being formed of several delicate
superimposed layers, it is natural to suspect that the defective
intelligence of idiocy may be due to a defective development
or to an entire absence of one or other o£ tt\^ \i\^^'t ^*l ^<^^^

184 PATHOLOGY OF MIND. [cHAr.

layers, which may be presumed to minister to the more abstract
functions of mind.

Thirdly, it must be admitted that, all question of defect of
physical structure put aside, the extremest derangement of func-
tion may be due to chemical changes in the complex constitution
of nerve-element — changes which, in the present state of know-
ledge, are still less discoverable than physical changes. Examine
the cells of a man's brain at the end of a day of great mental
activity, and at the beginning of a day after a good night's
rest ; what difierence would be detectable ? None whatever ;
yet the actual difference is between a decomposition and a
recomposition of nerve-element — between a capacity and an
incapacity of function.

It is beyond question, then, that there may be modifications of
the polar molecules of nerve element, changes in its chemical
composition, and defects in the physical constitution of nervous
centres, which, entirely undetectable by us, do nevertheless
gravely affect function, and are so attested. As defective sensi-
bility and motility betray defective motor and sensory centres,
so defective intelligence betokens defective mind-centres.

This is a conclusion which ought to be kept well in mind
when we are tempted to speculate concerning the unknown
physical conditions of an inherited predisposition to insanity.
To affirm that all men are born equal, as is sometimes heedlessly
done, is to make as untrue a proposition as it is possible to
make in so many words. There is as great a variety of minds
as there observably is of faces and of voices : as no two faces
and no two voices are exactly alike, so are no two minds exact
counterparts of one another. Each person presents a certain
individuality, characteristic marks of features and disposition
which distii^guish him from any other person who may resemble
him ever so closely ; and I hold it to be true that every special
character which is displayed outwardly is represented inwardly
in the nerve-centres — that it is the outward and visible sign of
an inward and invisible constitution of nerve-structure. Men
differ greatly, then, both in original capacity and in quality of
brain : there is a continuity of intelligence between the highest
genius and the lowest stupidity, distinguished men being raised

THE CAUSATION AND PREVENTION OF INSANITY. lefr'f

mucli above the average standard of ability as idiots are suuk
below it. In some persons there is the potentiality of great and
varied development, wliilat in others there is the innate inca-
pacity of any development There are manifest differences
in the fundamental functions of reception and retention
some the mental reaction to impressions is sluggish and in-
complete, and, without being idiots, they are slow at perceptioa
and stupid ; iu others, the reaction, though not quick, is veiy
complete, and they retain ideas firmly, althougli they are slow
in acquiring them ; in some, again, tlie reaction is rapid and
lively, but evanescent, so that, though quick at perception, they
retain ideas with difficulty; while in others the just equili-
brium between the internal and external exists by which the
reaction is exactly adequate to the impression, and the conse-
quent assimilation is most complete. Those natural differences
in the taking up of impressions plainly hold good also of the
further processes of digestion and combination of ideas, which in
the progress of mental development follow upon the concrete
perception. It is easy to perceive then that we have, as original
facts of nature, every kind of variation in the quality of mind
and in the degree of reasoning capacity, and that it is as gross a
mistake to endow all persons with a certain fixed mental poten-
tiality of uniform character as it woidd be to endow them with
the potentiality of a certain fixed bodily stature.

Viewed on its physical side, as it rightly should be, a predis-
position to insanity means an actual defect or fault of some kind
in the constitution or composition of the nerve element which
functions as mind ; there is an instability of organic composition,
which is the direct i-esult of certain unfavourable physical ante-
cedents. The retrograde metamorphosis of mind, manifest in
the different kinds of insanity, and proceeding as far as actual
extinction in extreme dementia, is the further pliysical conse-'
quence of the hidden defect, I have insisted much that the
physical structure of the mental organisation embodies in its
nature and gives out in its function the kind of activity which'
deteiTuined its formation, and I desire now to have it particni
larly noticed that the defective nerve-structiire of an insane
redisposition is an example of this truth. "W. o-^fes \te mx\%\r^Si&

I

I

I

I

I

I

186 PATHOLOGY OF MIXD. [chap.

nature to the unstable and ill-re^uIated conduct of parents or
other ancestors ; heing the materialization of past, it ia the
potentiality of future, irregularities. It ia easy to point, on tlie
one hand, to the nervous substance of the infertile idiot's brain,
and on the other hand, to that of the philosopher's, and to main-
tain that the kind of nurve-structure of which they are con-
stituted is the same, as it certainly appears to be ; but so long
as we have no exact knowledge of the constitution of nerve-
elemeut such an assertion is an unwanantable assumption,
and, while the functional effects are so vastly different in the
two cases, there are valid reasons to contradict it.

The conclusion, then, which we have reached is, that an indi-
■vidual who, by reason of a bad descent, is born with a predis-
position to insanity has a native nervous constitution which,
whatever name may he given to it, is unstable or defective,
rendering him uneq^ual to bear the severe stress of adverse
events. In other words, the man has what I have called the
insane temperament. Were it thought fitting to give a name to
this temperament or diathesis, as in algebra we use a letter to
■represent an unknown quantity, it might properly be described
as the J}iathesis ^asmodica or the Neurosis spaamodica ; such
names expressing very well an essential character of the tem-
perament— that is, the want of equilibrium between the different
nervous centres, their tendency to in-coordinate and disruptive
action There is some inherent instability of nervous element
whereby the mutual reaction of the nerve-centres in the higher
walks of nervous function does not take place properly, and due
consent or co-ordination of function is replaced by irregular
and purposeless independent action. The person is prone under
all circumstances to strange or whimsical cranks of thought and
caprices of feeling, or to eccentric or extravagant acts, and likely
under the pressure of extraordinary circumstances to suffer an
entire overthrow of his mental equilibrium i there is, as it were,
a loss of the power of self-control in the nerve-centres, an inca-
pacity of calm, self-contained activity, subordinate or co-ordinate,
and energy is dissipated in explosive discharge, which, like the
impulsive action of the passionate man, surely denotes an irrit-
able weakness. For here, as elsewhere, co-ordination of function

^H and

THE CAUSATION AN'P PREVEXTION OF INSANITY. l«t

signifies power, innate or acquired, and niarlts exaltation of;
organic development; self-restraint being a. higher power thai
sel f-aban donme n t.

Is it not plain how impossible it is to do full justice to any
individual, sane or insane, by considering him as an isolated
fact! Beueath liis conscious activity and reflection there lies
tlie unconscious inborn nature which all unawares mingles con-
tinually in the events of life — the spontaneity whence spring
the sources of desire and the impulses of action; for the con-
scious and the uuconscious, like warp and woof, together con-
stitute the texture of Ufe. No one, be he ever so patient and
apt in dissimulation or crafty in reticence, can conceal or mis-
represent himself always ; in spite of consummate art his real
nature reveals itself constantly by slight and passing signs, of
which he is liimself unaware, in the movements of the part
whiuh he plays, and bursts out of the restraints of hypocrisy
in the most earnest pulsations of bis life. The inborn nature
constitutes the foundation upon which all the acquisitions of
development must rest ; it ia the substratum in which all con-
scious mental phenomena are rooted. When it is defective
radically, no systematic labour will avail to counterbalance
entirely the defect : if the attempt be made to build tlie super-
structure of a large, vigorous, and complete culture upon tiie
rotten foundations which an inherited taint of nerve element
implies, something will be wanting ; some crack in the building
will betray the instability of the foundations, even when the
whole structure does not fall " in ruiu hurled." Any mental
philosophy which takes not notice of the foundations of the
character, but ignores the important differences of individual
nature, does not truly reflect the facts, and must be provisional
and transitory. It is guilty of the same error as that into which
introspective psychology falls when, isolating the particular

ite of mind, and neglecting the autecedent conditions upou
which it has followed, it pronounces the will to he free ; by
isolating the individual, and forgetting that he is but a Hnk in
the long chain of nature's organic evolution, it transforms him

ito an abstract and impossible entity, and often judgaa

I

■to an abstract and impossible entity, and oltcn juugaa tufc i h
Uons with an unjust judgment. flH

MBS PATHOLOGY OF MIND. [i-H

^^M Here I have tho misfortune to be in seeming contradiction
^^K with so sonnd and sober a thinker as Locke, who, admitting
^^f natural faculties to be great gifts, declares acquired habits to be
I of more value, and many excellences which are looked upon aa

natural eadowTnents to be, when examined into more narrowly,
the product of exercise. " Defects and weaknesses in men's un-
derstandings," lie says, " come from a want of right use of their
niiuds. There is often a complaint of want of parts, when tho
fault lies in a want of a due improvemeut of them." No doubt

I that is so ; at the same time it is certain that there is often-
times a want of parts wliicb no training will make good, and
that the hope of training rests upon a po.ssession of the ordinary
gifts of nature. If a man's nature have a radical flaw in it, he
can no more get entirely rid of it by training than the idiot,
whose want of parts is incontestable, can raise his intelligence
I to the average level by much study, or than a short man can, by

taking thought, add one cubit to his stature. Acquired habits
may do much to compensate natural deficiencies, but the mis-
fortune is that the deficiency often shows itself in a constitutional
inability to acquire the habit. Moreover, superior excellences
af parts can only be built upou corresponding foundations.
^nc 2- QuajUity, Quality, and Dislribvtion of the Blood. — The grey
^^K centres of the bi'ain, and the cortical layers of the hemispheres
^^K especially, are richly supplied with blood-vessels, even when
^^m comparison is made with the notably abundant supply of the
^^B apinal centres ; fully one-fifth of the whole quantity of the
^^M blood in the body going to the head. Tlie ideational centres
^^k need for the due exercise of their functions a rapid renewal of
^^B arterial blood, an active interchange of some kind continually
^^H going on between it and their elements ; indeed, as I have pre-
^^m viously aigued, the life of a nerve-cell may be looked upon as a
^^K continual metastasis, its substance being decomposed during
^^B function and recompounded during rest, and the blood being the
^^B agent tliat brings what ia wanted for repair and cai'ries away
^H what is effete after function. The quantity and quality of the
^^K blood, tberefoi-e, circulating through tiie supreme centres, must
^^K affect their functions in an important manner, as will appear
^^H iDoi'e clearly when it is considered that they are the most aensi-

■bh

THE CAUBATION AND PREVENTION OF INSANITY. ISftil

tive elements of the body in this regmd. When the most expert
chemist ia un.ible to detect anything unusual in the atmosphere
of a room in wliich many people are met together, a delicate
woman may get a headache and actually faint away. If a mix-
ture of air and carbonic acid in certain proportions be inspired
like chloroform, it will, like it, act aa an anjeatbetic, paralyzing

iDBciousness ; and if the blood "be charged with a stronger dose J
the gas, the nerve-elements are stifled outright. I

Wfcen there ia a rapid flow of healthy blood through tho"
supreme cerebral centres, a quick interchange goes on between it
and the nerve-cells, and the excitation and interaction of ideas
proceed with vivacity. The effect; of active thought is to produce
such a determination of blood, which in turn is the necessary
condition of the continuance of the active functiou. But when
a natural determination of blood degenerates into a greater or
less stasis oi congestion, as it may easily do when intellectual
activity ia too much prolonged, or when congestion is other-
wise produced, then there is an inability to think ; torpor and
confusion of thought, depression and irritability, swimming in the
head, disturbance of sight and of hearing, delirium and convul-
sions in the worst event, testify to a morbid condition of things.
It is striking how completely a slight congestion of the brain

'ill incapacitate a person for mental activity, and how entirely
;he strong man is prostrated thereby : an afllicting stagnation of

deaa accompanies the stagnation of blood ; and be, heretofore
so strong and self-confident, realizes in vivid affright on how
slight a thread hangs the whole fabric of his intellect. If the
morbid state should, instead of remaining passive, or passing
away altogether, become active, aa it doea when actual inflam-
mation occurs, then the function of the'cerehral centres becomes
iiTegular and degenerate j co-ordination is lost, as it is in the
spinal cord under like circnmstances, and a wild and incoherent
delirium attests the independent and, if I might so speak, con-
vulsive action of the different cells : the delirious ideas are the
expression of a condition of things in the supreme centres which
is the counterpart of that which iu motor centres utters itself
in spasmodic movements or convidsions. The destruction of

oo-ordination of function is the abolition oE NoVv^ioti-, vc^^ '«>^^SeA^|

o^H

I

f 190 PATHOLOGY OF MIND. [<

purposeless or dangerous acta as the delirioua being pevforma are
dictated by tiie morbid ideas that are excited by the abnormal
physical condition. Some writera have thoughtlessly spoken of
this degenerate activity in its earlier stages as increased mental
activity, as they have also spoken of active inllammatioa aa
increased vital action; not otherwise than as if convulsions
were accounted signs of strength, or as if tlie tale of an idiot,
because it is full of sound and fury, though signifying nothing,
wei-e the index of high mental activity.

Dr. Mason Cox pointed out long ago that the pulses in the
i-adial and carotid arteries sometimes differed from one another
in the insane, being soft and weak in the former — for it is seldom
much affected at the wrist even in active madness — when it was
fhll and hard in the latter ; and Dr, Burrows, who also called
attention to irregularities and discrepancies in arterial pulsa-
tion, took notice that the carotids might differ fi'onj each other,
and both or either of tltem from other arteiies. Of no small
interest, in relation to the influence of the supply of blood to the
brain, are the vigour and revival of function that are sometimes
imparted by an attack of fever to brain enfeebled by chronic
insanity; patients in even advanced state of disease may be-
come quite rational for a time during fever, and relapse after
I its Bubsideneo ; or a demented patient, who usually exhibits no
\ spark of intelligence, may quicken into a certain mental activity .^

' Exninples o£ such tempornry revivnl of nerebral fanctions during
fever Lave been related by vaiioua nuthore, and iirc well known to pliysi-
daiia wlio have much to do with tlio insane. The following may suffice
liere: — "The following case, related to me by a medicnl friend, will serre
L to siiow that even in idioay the mind may be rather suppressed than
E destroyed. A young woman, wbo waa empluyed as a domestic servant by
fr Ihe father of tjje refater when he was a boy, became insane, and at length
Bank into a slate of perfect idiocy (dementia). In tliia condition she
remained for many years, when she was attacked by a typhus fever ; and
my friend, having then practised some time, attended her. He was sur-
prised to obsen'e, as the fever advanced, a development of the mental
powers. During that poriod of tlie fever when others are delirious, this
patient was entirely rational. She recognized, in the face of her medical

[ attendant, the son of her old master whom she had known so manv yearn

^^^V before ; and she related many circtimstances respecting the family, and
^^R otiieri which had happened to herself in her earlier days. But, aks I it
^^H was only the gleam o£ reason ; as the fever abrtted, doudx again enveloped
^^V the mind ; she sank into licr fonnor deplorable state, and remained iu it

r

THE CAUSATION AND PREVENTION OF INSANITY. 191

Several eases have been recorded in which actual recovery EtohiSj
insanity Laa followed an intercurrent attack of typhoid fevesr,
scarlatina, and variola ; but the rule certainly is that the ame-
lioration or modification of the mental state which commonly
occurs during the fever psisses away as the fever subsides. It
may be presumed that the excitement and the quickened circu-
lation of the brain either stimulate the indolent and exhausted
nerve-cells in which force is generated, or open up obstructed
paths of association, not otherwise than as the stimulus of alcohol
stirs up forgotten ideas in a healthy brain and quickens their
associations. If this be so, it is an interesting proof tltat the
nerve-cells and the paths of normal association are not so
damaged or broken up as to be beyond restoration even in ad-
I Tanced madness ; the former are deadened and the latter blocked,
B«a it were, but the continuity of structure is preserved ; and
Mimth are capable of doing their proper work again when reani-
Elnated by a strong stimulus of a suitable kind. J

Since the time of Hippocrates it has been known that wh^
there is too little blood in the brain symptoms are exhibited very
like those which are produced by a congestion of blood: pain and
swimming in the head, mental torpor and confusion of thought,
aH'ections of the senses and of movement, and in extreme cases
convulsions and delirium, occur in consequence of anteniia of the
brain as certainly as they do in consequence of congestion. In
both eases the due nutrition of tlie nerve-cell, which is the agent
of cerebral function, is greatly hindered ; and much of the ill
effect is similar, though the cause appears to be so different.
The intimate causes are not so different as they seem, when we
proceed to analyse the conditions comprised under the terms
aniemia and congestion. In that unceasing active relation
betweea the organic element and the blood by which the due
reparative material is brought and waste matter carried away,
it amounts to much the same thing whether, through congestive

I stasia of the blood, the refuse ia not carried off and reparatii'e
jaaterial brought to the spot where it is wanted, or whether a
i

1

e- ■

itil her dautli, wliicli Ijappened a few years af tenvards. " — Descripfion of

I iiefreaf nenr Fort, p. \m. By Samuel Tuke, 1813. See also J^ -^

Mmlal fictMiee, July, 1872.

i^J

^^H cir

182 PATHOLOGY OF MiND.

[oJif

like result ensues by reason of a defective blood and deficient
circulation: it is little matter to the inhabitants whether the
street is blocked, or whether its entrance is closed, so long as
free circulation is prevented.

If the carotid arteries of a dog be tied, and pressure be then
made on its veitebral arteries, as was done by Sir A. Cooper,
the functions of the brain are entirely suspended ; the animal
falls into a deep coma, its respiration ceases in a few moments,
and it appears to be dead ; but if the pressure be removed from
tlie vertebral arteries, the niauifestations of life reappear, and
the animal regains rapidly the integrity of its cerebral functions.
In like manner sleep may be produced in the human subject by
strong pressure upon the carotid ai'teries in the neck ; and if we
may believe the authority of an old writer on insanity, sucli
pressure has, while it was continued, actually suspended mental
excitement sometimes, and restored intelligence. In melan-
cholia and in dementia the languid circulation in the cold and
livid hands and almost insensible skiu is very notable ; and it
is plain that if the cerebral circulation is in anything like the
saoie relaxed and feeble state there is quite enough to account
for the mental symptoms. The wanderings of mind just before
going to sleep, the delirium which breaks out sometimes as
convalescence from fever seta in, the distress of the melancholic
patient when he wakes in the morning, are perhaps due in part
to a diminution of the proper blood-supply to the brain. It
should be noted that an irregularity in tljc blood-supply with
consequent derangement of nutritive action will lead to a con-
dition of brain comparable with what we call irritation in other
organs ; falling short of actual inflammation, it is marked by
an undue impressionability, a diminution of proper functional

1 energy, a ready excitability to action of a perverted kind ; and
it is the exact counterpart in the highest centres of a similar
condition in the sensory and motor centres wliich, similarly
caused, shows itself in those perversions of sensation and motion
which are classified as hyperiEsthesia and hyperkinesia.
Temporary irregularities in tlie supply of blood to the
supreme nervous centres may, and often do, pass away without
Jeaving any ill consequences behind them ; but when they recur

I
I

i

THE CAUSATION AND PREVENTION OF ISSANITY. IS^^I

frequently, and become more lasting, their disappearance is by
no raeana the disappearance of the entire evil : the effect has
become a cause which continues ia action after the original cause
has been- removed ; and permanent mental disorder may be thus
established. Once the habit of morbid action ia fixed in a part,
it continues as naturally as, under better auspices, the normal
physiological action. It 13 always, therefore, of great import-
ance to give timely heed to the earliest warning of its presence
which morbid action gives ; but it is of paramount import-
ance to do so in the case of organic element so exceedingly ^A
susceptible and eo exquisitely delicate as nerve element. ^M

It ia a question whether one has not to do with locd rathef^J
tliau with general irregularities of the circulation in most cases
of mental derangement in which there is reason to suspect
vascular disturbance. So little do we yet know exactly of the
intimate physiology of the vaso-motor system that we can only
guess at the precise character and mechanism of these Iftcal
irregularities ; but we tnow enough to be sure ot a wide-reach-
ing and important function of the vaao-motor system in the
economy. Mental causes may no doubt occasion them ; it is pro-
bable tliat all active emotions are accompanied by changes in
the circulation through vaso-motor inhibition, and that such
vascular disturbances may be produced by them within the
brain very much as blushing is produced over the face and neck
by shame, or as relaxation of the sphincters is sometimes caused
^by fear. Then again circulation-disturbances within the brain
i^ill react upon the iunervatiou-centres of the heart and lai^e
vessels within the medulla oblongata, and so affect the pulse
secondarily : in melancholia, for instance, we sometimes notice
a slow, irregular, and intermittent pulse, wliile the patient is
and anxious and apprehensive, which becomes full
id regular ao soon as the anxiety and apprehension pass off.
levere primary disease of the brain probably acts upon the
pulse through the same mechanism; fur a pulse of about sixty-
eight, quick and jerky, not actually intermittent, but irregular,
being now faster and now slower, without any evident regularity
its irregularities, is thought to warrant a strong suspicion
the existence of such disease. A\)doi\\\i;\a\ 6;\E\.M\\i^^'yi^ '»i^^

^^^^epressed
^^^pad regu
^^Peevere p'

^p one

PATIIOLOGY OF MIND. [ruAfJ

also gravely affect the cerebral vaso-niotor centres ; in relation
wliich an experiment by Goltz is instructive. On tnppii
sharply on the abdomen of a frog the heart and veaaela of whit
lie had previously exposed, he found that after a tap or two the
heart stopped, beginning to beat again after a short pnuse. At
the same time the abdominal vessels, especially the veins,
dilated widely. The tapping irritates the mesenteric uervetf;
the impression is transmitted by them to the inhibitory centres
in the medulla; and the consequence is, first, inhibition of the
heart, and, secondly, of the vaso-iuotor centres of the intestinal
vessels. What is to binder disorder of an abdominal
from producing in like manner a local circulation- disturbani
within the brain ? We know it will produce a condition favoi
able to certain emotional moods, and we suspect such mo(
to be accompanied by vascular changes. The more closely
look, the more clearly it appears that the phenomena of
whole mental and bodily economy form one circle of operatioi
essentially intervvorking, and ever coming back upon one anothi

A vitiated blood quickly affects the function of the supreme'
cerebral centres. Alcohol yields the simplest instance in illus-
tration of tlie disturbing action on mind of a foreign matter
introduced into the blood from witiiout : here, where each phase
of an artiBcially produced insanity is passed through suc-
cessively in a brief space of time, we have the abstract and brief
chronicle of the history of insanity. Its first effect is to pro**
dnce an agreeable excitement, a lively flow of ideas, and ^
general activity of mind — a condition not unlike that whieilli
oftentimes precedes an attack of mania; then there follow, aS
in insanity, sensory and motor troubles and the automatic exci-
tation of ideas which start up and follow one another without
order, so that more or less incoherence of thought and speech is
exhibited, while at the same time passion is easily excited,
which takes different forms according to the individual tempera-
ment ; after this stage has lasted for a time — in some longer, in
others shorter — it passes into depression and maudlin melancholy,
as convulsion passes into pamlysis ; the last scene of all being
one of dementia and stupor. The difTerent pbnsos of mental
ffisorder are compressed into a short peiiod of time because the

]

^^n TnH CAUSATION AND PREVENTION OF INSANITY. ISI^H

action of tlie poison is quick and transitory ; tut we have only
to Bprefid tlie poisonous action over years, as the regular
drunkard does, and we get a chronic and enduring insanity in
which the foregoing scenes are more slowly acted. Or, if death,
cutting short the career of the individual, puta a stop to the
i'ull development of the tragedy in his life, we may atill have it
played out in the lives of his descendants ; since the drunkenness
of the parent sometimes hecomes the insanity of the offspring,
which thereupon, if not interfered with, goes through the down-
ward course of degeneracy descrihcd. It is worth while to take
note by the way how differently alcohol affects different people
according to their temperaments, ever biinging forward the
unconscious real nature of the person : one it makes a furious
maniao for the time being; another it makes maudlin and
melancholic ; and a third under its inHuence is stupid and
heavy from the beginning. So it is with insanity otherwise
caused : the individual constitution or temperament, rather than
the exciting cause of the disease, determines the form which the
madness takes. An exact differential pathology would involve ^^H
the vastly dilScnlt knowledge of what constitutes individual'^^^
temperament. ^^H

Other poisons besides alcohol, such as opium, belladonna,
Indian hemp, stimulate and ultimately derange the function of
the supreme cerebral centres. It is interesting to notice that the
different nervous centres of the body evince elective affinities
for particular poisons : while the spinal motor centres have a
special affinity for strychnine, the cerebral centres seem to be
untouched by it; belladonna, on the other hand, rather depressea^^M
spinal activity, but acts powerfully upon the centres of con-^^H
sciousness, giving rise, at an early period of its action, to^^H
delirium characterized by hallucinations and illusions ; and
Indian hemp seems to act mainly on the sensory centres,
exciting reraarbablo hallucinations. That medicinal substances
do display these elective affinities is a proof, at any rate, that
there are important intimate differences in the constitution or
composition of the different nervous centres, notwithstanding
i^at we are unable to detect the nature of them ; and it may

we have in these different effects of ■poi^o'aa otv W\c Wi'wav.'i.

PATnOLOGY OF MIKD, [chap.

^^B system the promise of a useful means of investigation into tlie
^H constitution of the latter. Albeit the rapid recovery which
^^f takes place from tlie effects of these poisons proves that the
combinations wJiicli they form with nerve element are tem-
porary, it must he home in mind with regard to them, as with
regard to alcohol, that the nervous system, when repeatedly
exposed to their poisonous influence, acquires a dispositioiT to
irregular or morbid function, even when they are not present ;
80 that more or less marked mental disorder ensues Bometimea
from their continued abuse : they are eiScient to initiate a de-
generacy which then goes on of itself. The paralysis produced
by lead and mercury in workmen who have been long exposed
to their poisonous effects, and the utter mental prostration and
fatuity that are witnessed in the worst cases, are further proofs
of the injurious action upon nerve-centres of poisons that may

■ be detected in, and extracted from, the tissues.
But the condition of the blood may be vitiated by reason of
something bred in it, or by reason of the retention in it of some
substance which should rightly be excreted from it "Without
any change whatsoever having taken place in his external
relations, the presence of bile in his blood shall drive a person
to regard hia surroundings and his future in the gloomiest light
imaginable ; he may know that a few hours ago things looked
quite otherwise, and may beheve that in a few hours more they
^H will again have a different aspect, yet for the time being he is
^^b B victim of a humour which he cannot withstand. Philosophy
^^K is of little avail to him; for philosophy cannot rid him of that
^^B condition of nervous element which the impure blood has
^^M engendered, and which is tlie occasion of his gloomy feelings
^^M and painful conceptions. Carry this morbid state of nervous
^^B element to a further stage of depression and make it last, there
^^M ensues the genuine melancholia of insanity. In like manner tlie
^^M presence of some product of incomplete nutrition in the blood
^^P of a gouty patient gives rise t-o an irritability of temper which
^^B no strain of mental control can remove, though it may succeed
^^B sometimes in suppressing its manifestations. The mental tone
^^L h^g, as already set forth, the expression of a physical conditioii
^Ht &f nervous element, is sometimes beyond conscious management,

THE CAUSATION AND PHEVESTION OF INSANITY. 19T 1

jii9t 03 the delii-ium and convulsions of the patient dying from
nrsemio pnisoning are beyond control. All writers on gout are
agreed that a suppressed gout will produce severe meutat dis-
order, and that the sudden disappearunce of a gouty swelling is
sometimes followed by such an outbreak. After the cessation
of the inflammation of the joints gouty mania sometimes occurs,
cliaracterized by acutely maniacal symptoms, with heat of head
and fever; ending favourably in the slighter cases, but in
severer cases passing into inflammation of the membranes,
serous elTiiaion, and coma. Lord Chatham, who was so great a
martyr to the disease, had an attacli of distressing melancholy
lasting for nearly two years, from which he only recovered after
an attack of the usual gouty paroxysm, which had not occurred
once during the season of his mental disorder. Most writers on
insanity and on gout make mention of persona subject to fre-
quent attacks of gout who had none while suifemig fi-om aa
attack of insanity.

It admits of no question that every degree of mental disorder,
from the mildest feeling of melancholic depression to the extcem-
est fury of delirium, may be due to the non-evacuation from the
blood of the waste matters of the tissues ; but as we know very
little at present of the nature of those waste products of retro-
grade metamorphosis, and of the different transformations which
tliey undei^o in the body before they are eliminated by excre-
tion, we must rest content with the general statement, and , set
ourselves in practice to prosecute rigorous inquiries into the par-
ticular instances. In-egularities of menstruation, which are so com-
mon in insanity, are of importance in regard to this question;
the return of the function at its due season not unfrequently
heralding recovery, and, on the other hand, severe exacerbations
of epilepsy and insanity coinciding often with the menstrua!
period. Whether the case be one of mere retention in the
blood of what should be excreted from it, or whetlier nervous
sympathy plays the greater part in what takes place, I know
not ; but there can be no doubt of the fact that menstruation is
oft-eutimes suppressed during an attack of mental derangement,
f and of the second fact that cases are on record, more or less
pike thsit well-known one related by EstLuitcil oC ws. \vfiWAfe -e^

I

Ir iM
^98 PATHOLOGY OF MIND. [chaS^^I
wliose menses Iiad ceased for some time, and who recovered ll^^^|
senses directly they began to flaw. I^^H

When we reflect that the blood is itself a living, deve1opiS^^^|
fluid, — that, " biirnished with a living splendour." it circulates
through the body, supplying the material for the nutrition of
the various tissues, receiving again their waste matter and

»oapiying it to those parts where it may either he appropriated
by nutrition or elimiuated by secretion,— it ia plain that multi-
tadiuous changes are continually taking place in its constitution
and composition -, that its existence is a continued metastasis.
There is wide possibility, therefore, as there is partial evidence,
of abnormal changes in some of the manifold processes of its
complex life and function, such as may generate producta
hurtful or fatal to the nutrition of the different tissues. The
blood itself may not reach its proper growth and development
by reason of some defect in the function of the glands that
minister to its formation, or, carrying the cause still further
back, hy reason of insufficient food and of wretched conditions
of life ; there is in consequence a defective nutrition generally,
as in scrofulons persons, and the nervous system shares in the
general delicacy of constitution ; though quickly impressible
and lively in reaction, it is irritable, feeble, and easily exhausted.
Poverty of blood, without doubt, plays the same weighty part
in the production of insanity as it does in the production of
other nervous diseases, such as hysteria, chorea, neuralgia, and
even epilepsy. In the condition known as anjemia, we have an
ohservaljle defect in the blood and palpable nereous suffering
in consequence ; headaches, singing in the eais, spaiks of light
before the eyes, giddiness, low spirits, and susceptibility to
emotional excitement reveal the morbid effects. The exhaustion
produced by lactation in some constitutions is a recognized
cause of mental derangement; and a great loss of blood during
childbirth has sometimes occasioned a sudden outbreal;. Tlie
delirium of starvation is probably an antemic delirium ; it '
is marked by mental prostration and imbecility in the
beginning, and then by maniacat deliiium, perhaps with visual

I hallucinations, which is followed hy coma and death, with or ^h
Jrithout convulsions. ^^M

TUE CAUSATION AND PREVENTION OF INSANITY. 199 ■

"VVTiile we can detect an evil so obvious as a great loss of blood
or a deficiency of iron in Ihe blood, lliere are good reasons to
tliink that other graver defects in its constitution or develop-
ment, of which we can give no account at present, do exist and
give rise to secondary nervous degeneration. It Is in this way
probably that ill conditions of existence, — as overcrowding, bad
air, insufficient food and light, intemperance, and the like, — lead
to defects of nervous development, or to actual arrest tlicreof,
and thus produce mental as well as physical deterioration of the
race. Leucocyt]uEima, oxaluria, and phosphuria are states of de-
fective nutrition owing to imperfect digestion and assimilation,,,
in which symptoms of mental discomfort or distress are common
and notable. Persona who suffer from oxaluria are usually much
depressed, anxious or apprehensive about themselves, hypochon-
driaeal, nervous and susceptible ; in phosphuria there is com-
monly also great nervous irritability ; and the late X>r. Skae
thought that there was a form of insauity of a melancholic type
associated with or directly dependent upon each of these condi-
tions. I know not under what more fitting heading than deterio-
ration of blood to place the mental derangement which occurs
in pellagra, and is called pellagrous ; for, being caused by the
use of diseased Indian com as an article of food, it is a condition
of grent bodily aud mental debility. The symptoms are usually
those of melancholy and fatuity with propensity to suicide;
sometimes they are maniacal ; and some cases are said to evince
a singular dislike to the sight or touch of water because of thft
vertigo which it instantly produces.

There is no want of evidence that organic morbid poisons,
bred in the oi^aaism or introduced into it from without, v/Wl
act in the most baneful manner upon the supreme ner\'ous
centres. With what quick destructive force certain morbid
materials bred in the blood, or passing into it, nmy act, is
shown in certain cases of so-called putrid infection in wliieh
the patient dies after an injury or a sut^cal operation before
there has been time to feel the after-consequences, or in some
cases of malignant typhus where the virus is directly fatal to
nerve element before the fever has had time to develop itselt
It is probable enough that a virus which, ■wWb. TO-at's&'OTjXs

*

4

os^^l

I

|lOO PATHOLOGY OF MIND. [t

produces fatal results, will, when acting with less intensity,
give rise to nervous derangement which stops short of deatli.
That organic poisons do act in a definite manner on the organic
elements, and give rise to definite morbid actions, is proved by
the constant symptoms of such diseases as syphilis and small-
pox. Now the general laws observable in the actions of morbid
poisons appear for the most part to be like those which govern
the action of medicinal substances; and as the Woorara poison
completely paralyzes the ends of the motor nerves and does not
affect tlie muscles or the sensory nerves, or as strychnia poisons
the spinal centres, and leaves tlie cerebral centres unaETected, so
it is conceivable that a particular organic virus may have a
predominant affinity for a particular nervous centime and work
its mischievous work there, ^V^lether that be so or not, what
we do notice is that in some conditions, natural or acquired, of
the nervous system a morbid poison docs act with particular
intensity upon it or show a particular affinity for it. The
syphilitic virus usually affects the nervous system more or less
severely at one period or other of its action ; but in some
instances it appears to attack the nervous system specially, or
to concentrate its action upon it, giving rise to an acute mania
at an early stage of its course. Commonly, however, it is at a
much later stage that the brain suflei's, when syphilitic pro-
ducts, so-called ipimmata, are formed on its surface, or within
its Eubstance, and dementia gradually ensues in consequence.

There are eases on record, again, in which mental derangement
has appeared as the iutermitteuf symptoms of ague; instead of
the usual symptoms of ague the patient lias had an intermittent
insanity in regular tertian or quartan attacks, and has been cured
by the treatment for intermittent fever.' Sydeidiara obsci-ved and

^ A yonng man in an agneiah district suffered from five brief attacks ot
mental detangement, one occurring every otlier day. Tlie allEcka began
witli nn indeBcribable feeling of pain in tlie region of the heart, and with
Blruiig pulBations of the lieart. This was the starting-point of tlie deli-
rium, from which the patient recovered after a deep sleep. He was cured
> by quinine. — A Btrong peasant, aged thirty, who had never had ague
tliough he lived in an agiieish district, was suddenly attacked with insanity.
He believed himself to be Jesiin Christ, and those near him to be witched,
' «nd acted with violence towards tliem. Hia bead was hot ; liia eyes were
'l Ted and wild ; hie pulse was quick and bis tongue while. Af isr cupping

THE CAUSATION AND PEEVENTION OF INSANITY.

described a species of mania superveninf; od an epidemic of in-
tennittent fever ; contrary to all other kinds of madness, be says,
it would not yield to plentiful venesection and pairing ; aliglii;
evacuations producing tlie relapse of a convalescent, and vio-
lent ones inevitably rendering tbe patients idiotic and incurable.

Griesinger and otbers direct special attention to cases iu
■which mental disorder has occurred in the course of acute
rlieumatism, the awelling of the joints meanwhile subsiding.
The patient ceases to complain of pain in the joints and be-
comes delirous; the excitement which he allows is of an in-
tense kind, too raging to leave him sensible to impressions;
he evinces acute fear, and would jump out of the window
or do some other act of unreasoning violence to himself After
the excitement is over there is much mental torpor and
confusion, or there is depression with taciturnity and moody
suspicions. Choreic movements of all the voluntaiy muscles,
sometimes of a violent character, may accompany the mental
symptoms, and are in a few cases followed by temporary para-
lysis. It is by no means certain, however, tliat a delirium of
tliis sort is due to the action of a morbid or otlier poison ; it
may be due to an actual transference or so-called metastasis of
the disease, or to other causes ; for wo know by other experience
that morbid action in oue part may overpower and suspend
morbid action in another part of the body, as when an attick
of insanity suspends the progress of phthisis or the paroxysms
of asthma, while it lasts, or aa when a violent mania occasions
the suppression of an accustomed discharge.

The viruses of acute fevers, as typhus and typhoid, scarlatina
and smallpox, may notably act in the most positive niaoner
on the supreme nervous cells, giving rise to mental torpor and
stupidity, or to an active delirium ; and, where they do not act
directly at the height of the fever to produce delirium, they still
predispose sometimes to aij outbreak of insanity during the de-
cline of the acute disease— a post-fobrile insanity. Kot only may

and the applicallon of ice to the head, he recovered, nnd for two dayt> 1
remained quite sound in mind. On the fourth day, however, exactly at I
the Baiiie time, he had a similar sttatrk, and again a tliird, after tlirea davB f
nuiro. He was cured hy quinine.— D/e Polhologie vnd Thcrapit dtr ,
pgi/cliieckai KrankiieileiL Von Vr. W. GriiisiiiBer.

1

||*02 PATHOLOGY OF MIND. [<

a morbid poison thus attack the nervous system, or a part of it,
but it should be borne in mind that a particniar vinis will
most likely have its special effect, not otherwise than as 1
and coffee produce wakefulness, whilo opium produces sleep.

The first and mildest mentttl effect of a perverted state
blood is not positive delusion or incoherence of thought, haC
derangement of the mental tone. Feelings of singular discomfort
or depression, of irritability or uneasiness, testify to some modifi-
cation of the statical condition of nervous element ; and a great
disposition to uneasy emotion is the subjective side of this
[ state — the psychosis which is the expression of tlie disturbed
neurosis. It may exisb in different degrees of intensity, from
the alight irritability or gloom which goes along with a sluggish
liver, or the greater irritability which the urea in the blood of
the gouty subj:dct produces, to that profound depression which
we describe aa melancholia, or tliat active degeneration of
function which we designate mania. Though there may be no
positive delusion, the enmtional perversion existing by itself,
the ideas which arise under such circumstances do not fail to
show the influence of the morbid feeling with which they are
strongly tinctiired ; they are obscure, or painful, or, at any rate,
not clear and faithfully represenlative of external circumstances.
The morbid character of the depression lies, not in the depres-
sion itself, which would he natui'al or normal so long as there
waa an adequate external cause of it, hut in its existence
without any external cause- — in the discord between the indi-
vidual and his circumstances. But as it is an irresistible dis-
position of the mind to represent its feelings as qualities of the
r external object; as in all our mental life we continually make
I this projection outwards of our subjective states — it commonly
happens after a while that the victim of an internally caused
emotional perversion seeks for an objective cause of it,
and, thinking to find one, gets a delusion: being in discord
with the external, he establishes an equilibrium between himself
I and it by creation of ideal surroundings in harmony with his
[ inner life. The form which the delusion takes may be a natural
I eiy stallization or condensation, so to speak, of the particular mor-
ftlnd emotion which prevails, in which case the most trivial event

1

THE CAUSATION AND PREVENTION OF INSANITY. 203 |

may be overcliarged witli dispropottionafce emotion, and magnified
into a mighty trouble; or it inuy be suggested, as it often i^, by
some prominent external event Wliat we have to hear in miud)
with regard to the organic nature of the delusion is, that certain >
ideational tracks have now entered upon the habit of a definite ',
morbid action ; that the general commotion of nerve elementf^
which the emotional distiubance implied, has now brought itself
to a head in a particular form, of diseased action ; not otherwise
than as general inflammatory disturbance of some part of the
organism issues in a definite morbid growth thei'e. For although
a temporary emotional disturbance produced by bad blood may
completely pass away with the purification of the blood, yet
the prolonged continuance or frequent recurrence of such mor-
bid influence will inevitably end in the ideational centres, as
elsewhere, in chronic morbid action, which, once established, is
not easily got rid of

We may compare the growth of a delusion with the mode of
production of a general idea. As the general idea ia formed by
assimilation of the like and by rejection of the unlike iu
impressions — by respondeuce, that is, to similar and indifference
to dissimilar vibrations ; so in the growth of a delusion in the
mind there ia a respondence to, and therefore an affinity for or
natural selectiou of, impressions that harmonize with it, while
those that are not in liarniony with it are ignored. It is useless
to aigue against an insane delusion ; it lias taken a predominant
possession of conaciouaness, and there ia a discontinuity of
function between its tract and surrounding parts ; reasoning
can gain no hold of it any more than surrounding healtJiy
nutrition can gain hold of a tumour or other moibid growth to
check it. But the gradual influence of favourable surroundings
— to wit, a suitable moral atmosphere, distracting occupations,
diverting amusements, a steady reason able ni?ss of lil'e — will exert
an unconscious beneficial influence upon the uninfected mental
oi^anization, until the large part of it which lies outside the
morbid area gains strength enough to have a controlling hold
of the morbid action and to bring it by degrees into subordina-
tion to the laws of healthy function. Then the quasi- cataleptic
bondage of consciousness ia loosened, and d.Y^i^wSX-oso.x^ -^

PATHOLOGY OF MIND. [cr

^Bc04

^^V function is at an end ; the individual first suspects, then doubts,
^H finally disbelieves bis delusion.

^H It appears fi-om what I have said tliat tbe first effect of tlie

^^M chronic action of impure blood is to produce a general disturb-

^^^ auce of the psychical tone, or indefinite morbid emotion ; and

^^V that the fui-ther efiect of its continued action is to engender a.

^^m chronic delusion of some kind — a systematization of tbe morbid

^^M action. But a third effect of its more acute action, as witnessed

^^P in the effects of acute fevers and of certain poisons, is to

produce more or less active delirium and general incoherence

of thought : the poison is distributed generally through the

supreme centres by the circulation, and, acting directly apon

■ them, excites ideas rapidly and without order or coherence: the
delirium is not systematic, and there is good hope of its pass-
ing away. The approaches of tim sort of delirium in fever
illustrate many of the phenomena of insanity. First, there are
wandering thoughts and visions, known to be unreal, which are
described by the patient, who recognizes their character, as
nonsense ; then tliere follow vagne rambling talk, from which
be may be aroused by talking to him, though he falls back into
it as soon as he has answered, and visions, about the reality of
which he is uncertain and confused, assenting, perhaps, when
assured that they are unreal, but relapsing instantly afterwards

»iuto belief in them ; afterwards, as the disorder gets deeper
hold, a state of complete delirium ensues, when he cannot
distinguish between the real and the unreal, and the mind ia
entirely possessed by unreal images and false thoughts uncon-
trolled by impressions from without. It is a singular fact that
notwithstanding this febrile debrium resembles mania in many
respects, when its phenomena are analyzed, and notwithstanding
that its seat in tbe brain must be the same as that of mania, it
never does run on without intermission into that post-febrile
mania which sometimes occurs during convalescence. The febrile
delirium is clearly an incident or attribute, so to speak, of the
morbid process of the fever, coming and going therefore with
it ; the post-febrile mania is essentially a derangement of mind,
^^ to which tbe fever lias been a powerful predisposing cause, an

THE CAUSATION AND PKEVENTION OF INSANITY. 205 .]

noted, however, that a fixed idea baa continued soiuetimea for
a considerable time after the general delirium of fever : take,
for example, the cose of the physician who, after an attack of
typhus fever, believed for six months that he possessed a
country house and a white horse, neither of which had any
existence except in his imagination.

It ia necessary to apprehend clearly, and to keep steadily in
mind, that the relation between the supreme nervous centres and
the blood is fundamentally of the same kind as that between
other parts of the body and their blood-supply ; and that the
disordered mental phenomena are the functional exponents of
morbid organic action. Pirmly grasping this just conception,
as we may do by calling to mind the mode of nutritive action
in other parts of the body, vk get rid of the notion of a delu-
sion as some abstract, ideal, and incomprehensible entity which
comes, we know not how, and recognize it as the mental
expression of a definite morbid action in one or other of the
supreme centres ; neither more nor less wonderful, therefore, than
the pei'sistence of a dciiuite morbid action in any other organ.
If at a time when there is defective or disordered nutrition
of the brain some striking event or some powerful shock pro-
duces an extraordinary impression on the mind, constraining it
into a particular form of activity— in other words, engrossing
its whole energy in a particular gloomy reflection; or if tliG
individual's natural habit of thought be of a suspicions, of a
vainly conceited, or of a despairing character; what more in
accordance with analogy than that the predominant activity,
temporary or liabitual, should take on a chronic morbid action,
and issue in the production of a delusion ? Any great passion
in the sound mind notably calls up kindred ideas, which there-
upon tend to keep it up ; the evil eye of envy, the green eye of
jealousy sees only what feeds the passion ; and it ia plain that
the morbid exaggeration of this natural process must lead in a
weakened brain to the production of insane delusion.

3, Sympathy or Itejltx Irritaticn. — Like every other nervous
centre, or like any other part of the organism, the ideational
centres may be deranged by a morbid initation in a distant
of the body. "Why such morbid effects bIio\3.V\ 'oe, ^^^^i.-^.w-i.

4

4

206 PATHOLOGY OF MIND. [chap.

at one time and not at another, or in one person and not in
another, when the cause of irritation appears to be of the same
strength and character in each, it is impossible to say, just as it
is impossible to explain how it is that a wound in the hand or
elsewhere gives rise to tetanus at one time and at another time
to no such desperate consequence, or why epilepsy should be
caused by an eccentric irritation in one case and not in another.
" A fever, delirium, and violent convulsions," says Dr. Wliy tt,
"have been produced by a pin sticking in the coats of the
stomach ; and worms affecting either this part or the intestines
occasion a surprising variety of sjnnptoms." *

Hippocrates ascribed to sympathy the occurrence of certain
disorders which seemed to have no other cause than disease
elsewhere in the body, and both Aretaeus and Galen were aware
that the mind might be deranged by disease in other parts of
the body than the brain. On the whole, perhaps sympathy was
as good a seeming explanation of these effects as the modern
doctrine of reflex fiction; for the doctrine of a pathological
sympathy certainly brought into proper light the momentous
truth that the living organism is not mere mechanism, but a
physiological unity having an intimate and entire consent of
function. When we speak of reflex action, what is usually
meant is the transference of excitement from a sensory to a
motor nerve ; but the reflexion may be in the opposite direction
— ^from the motor to the sensory nerve, as, for example, when
severe pain along the spine follows violent coughing, or a
tickling of the throat is felt after long speaking, or facial
neuralgia is increased by muscular exertion.^ Moreover, the
reflexion may be from sensory nerve to sensory nerve : witness
the pain in the knee which betrays disease in the hip-joint, the
facial neuralgia which is excited by a toothache, and the pain
of a toothache that is felt in a neighbouring or in an opposite
tooth. So many and various are these pathological and physio-
logical reflex actions that we shall perhaps for the present do
best to embrace them under the wide term — sympathy.

^ Observations on the Nature, Causes, and Cure of Nervous^ Uypochon^
driacal, or Hysteunc Disorders. By Robert Wljytt, M.D. 1765.
^ Henle, Eandhuch der Rationellen Pathologie, 1840,

i

^HJb THE CAUSATION AND PREVENTION OF INSANITY. £0»^H

Amongst many other instances which might be c[uoteii to
illusti'ate tbia manner of pathological action is a striking case
recorded by Baron Larrey. A soldier, who had been shot in
the abdomen, had a fistulous opening on the right side, -whioh,^^!
passed inwards and towards the left. When a sound was intro-^^^^l
duced into this opening and made to touch the deeper parts, im- ^^|
mediately singular attacks snpervened: first there was a feeling
of coldness and oppressive pain, then a convulsive contraction of
the abdomen and spasm of the limbs took place ; after which the
man fell into a sort of somnambulism, and talked incoherently,
this stage ending after about thirty minutes in a melancholy
depression which from the time of the wound had been habitual
Larrey attributed the hypochondria and other nervous symptoms
to the injury which the cieliac Eixis had suffered from the balL
The direct efTect of the sympathetic system upon the brain, of
which this case yields a striking illuatration, Scbroeder van der
Kolk once verified painfully in his own experience.' After
great mental exertion and an unaccustomed constipation of a
few days, he was attacked with a fever, for which his physician, ^H
deeming it nervous, would not sanction any purging. When^^f
the fever had lasted for two days, hallucinations of vision ^^H
occurred ; he saw distinctly a multitude of people around him,
although he was quite conscious that they were only phantasms.
Tlie hallucinations continued for three days and increased, until
he got a thorough evacuation of a c[uantity of hardened fieces
from his bowels, when they vanished instantly. A man who
came under my observation, having suffered for more than a
year from profound melancholia, and who had become greatly
emaciated, passing at intervals pieces of tape-worm, recovered
almost immediately after the expulsion of the whole of the
■worm by means of a dose of the oil of male-fern.* Ifany like

i

Die Palbolof/ii vnil Tlicrnpii der Gdetetkrankheilen avf Annlomisrh-
'Jiynologisclier Griindlage. Von J. L, C Si^hroeder van der Kolk. 18(i3.
° Grieainger has Been deep melancholia occur in a hystericnl woman
alter accidental wound of tlJe eya by a Bplinler. Heraog relatee an inslanea
of insanity after the operation f or Btrabisraus. Jordeua tells of a boy who
waa attacked with f uriouB insanity in consequence of a splinter of glass in
the sola of his foot, which diHftppeared directly it was removed. — Ojj. cit.,
'83. See also a case related in Fhysiologij ofMiiid, p. 253,
III two instances," says Dr, Burrows, in liia Cominenlo.viiiB i«il.i«jj.™.V->i,
10

^V m I

PATUOLOGY OF MIND, [t

[cmi^l

I

.cases are on reconl in medical books; but it is not necessary to
lultiply instances in order to prove that a morbid irritation
in some distant part or organ of the body may he the cause
secondary functional and organic disorder of the supreme
nervous centres.

Affections of the ntenis and its appendages afford notable
examples of a powerful sympathetic action upon the brain, and
not unfrequently play an important part in the production of
insanity, especially of melancholia. Perhaps the best oppor-
tunity of studying the early stages of the genesis of melancholia
is afforded by the mental depression accompanying certain
uterine diseases. M. Azain investigated the histories of seven
cases of lypemania with suicidal tendencies, of one case of
simple lypemania with dangerous tendencies, and of one case of
hysteromania. He professed to have found granulations of the
neck of the uterus in five cases ; anteversion of the uterus, with
congestion of its neck and ulceration of the inferior lip, in one
case ; in three cases fungous and fibrous gtowthg of the uterus ;
and in one case painful engorgement of it with leucorrlicea,
Schroeder van dor Kolk relates the case of a profoundly melan-
cholic woman, who suffered at the same time from prolapsus
uteri, and in whom the melancholia used to disappear directly
the uterus was restored to its proper place ; Flemming mentions
two similar cases in which the melancholia was cured by the
use of a pessary, in one of them returning regularly whenever
the pessary was removed ; and in one iustanco I saw severe
melancholia of two years' dm-ation disappear after the cure of
a prolapsus uteri. Instances are on record in which a woman
has regularly become insane during each pregnancy; and, on

"I have known sudden mania originate from the irritntion of cutting the
denies tapieiitJa." ..." Violent nausea also from Be.t-sicknesB, con-
tinued for a few hours, lias produced mania in three instances witliin my
knowlcdgB."

M. Laurent (Annales Mt'Iico-Psycliohgiqiie., 1867) relates a cnao oE acute
delirium with refusal of food ending in death, which he sEcrlbed to an
ascarig IwrnbricoidM that was fonnd, afterdeath, in the woman's rasophngiig.
A sister bad died insane. On making litereiy researalieB he found coaes
recorded by Eaqiiirol and other autLora in which the presence of the wonn
in the stomach or cesiiplmgus hitd concurred with violent doliiious excite-
ment. The wonn in such place Heecns to he a moat powerful reflex irritant.

THE CAUSATION AND PKEVENTION OF IXSAKITY. 2{»B

the other hand, Guislam and Griesinger mention a case re-
spectively in which insanity disappeared during pregnancy,
the patient at that time only being rational. I have met with a
similar case in which a melancholic and rather weak-minded
woman was never sane except when she was pregnant; and
another instance of a young man-ied woman who, much tor-
mented by homicidal feelings, was free fmm them during
pregnancy. The late Dr. Skae included among his varieties of
mental disorder one which Le called the insanity of pregnancy;
the chief special characteristic of which seems to have been
that it occurred during pregnancy, and might sometimes be
loolced upon as a morbid exaggeration of the peculiar mental
moods exhibited by some women when in that stato.^

It is uncertain whether the puerpenil state acts as the occa-
lal cause of a maniacal outbreak by a kind of sympathetic
action, or whether it acta in some other way ; but there can be
no doubt of the fact that a woman is sometimes attacked with
mental alienation during or immediately after delivery, and that
her child may fall a victim to her frenzy. This form of puer-
peml insanity is different from the insanity of pregnancy ; dif-
ferent again from that which occurs at a later period after
delivery, and which is then probably due either to some sort of
blood-poisoning, or to a moral or physical shock undergone when
the nervous system is in a very susceptible state ; and different
again ffom that mental disorder occurring some weeks or months
after, and due seemingly to the exhaustion produced by lactation,
together with depressing moral influences. Under the name of
Puerperal Insanity have been generally confounded three morbid
states — namely, the Insanity of Pregnancy, Puerperal Insanity,
and Insanity of Lactation. Of 155 cases of so-called Puerperal
lanity admitted into the Edinburgh Asylum, 28 or 1806 per
Lt, were cases of the Insanity of Pregnancy ; 73 or 47"09 per

Slienck relates the history of a pregnnnt female, in whom the sight of
the bare nrm of a baker excited ao great a desire to bile and devour it,
that she compelled her husband to offer money t« tlis baker to allow her
only a bite or two from, bis ana. He menlious another pregnant female,
wlio had Huch an urgent desire to ent the flesh of her buBband, that she
killed him and pickled the flesh, that it might aorve for several bantmetK.
(Prociittaka on the Nervous jSysiein, Sjd, Sue, liaii&\a.\\on,"j

1

^H cent.

^H cent.

PATUOLOGV OF SUXD. [ci

[ ocnt. were eases of Puerperftl Insanity jiroper ; 54 or 34'8 per

I cent, were cases of Insanity of Lactation. Now these varieties,

differently caused, often present some diffurences of features.*

However it be that disorders of menstruation act, certain it is
tliat tliey exeruise great inflnence on the causation and on the
course of insanity. Most wonien are susceptible, irritable, and
capricious at those periods, any cause of vexation then affecting
them mucb more seriously tlian nsual ; some exhibit a dis-
turbance of character which mounts almost to disease; and, in
the insane, exacerbations of tlie disease frequently occur then.
In a few cases, a sudden suppression of the menses hns been
followed by an outbreak of acute madness ; but more often the
suppression has occurred some time before the insanity, and
acted as one link in the chain of causes. It should not be for-
gotten, however, that the suppression is not seldom an effect of
the mental derangement — whether as the result of a strong
sympathy with the mental trouble, or wliether it be an instance
of the same sort as the suppression of a profuse bronchitic

icharge oiid of other morbid fluxes by an outbreak of mania ;

: there is no small truth in the remark of Heberden that

idness, like gout, absorbs other distempers and turns them
to it.^ own nature. When nn^nstruation ceases entirely at the
obange of life, a revolution takes place in the system, which
favours the production of insanity in those predisposed to it,
and is sometimes enough to produce it. There ia a variety of
melancholic derangement occurring at this period which has
been described as dwiaderic insanity. Host women suffer

I Borne change of moral character in consequence of the
revolution %¥hicb the whole economy of the constitution under-
goes at the change of life. The age of pleasing is past, but not
always the desire ; morbid jealousy, exaggerated religious senti-
ments, wearisome hypochondriacal sufferings, a propensity to
stimulants are apt to show themselves : the main gratification of
life having been to attract attentions and to enjoy admiration,
new sources of indulgence and excitement must now be sought.

I

' Bee a very careful paper in tlie E/lmhurgh Medical Journal, 1865,
the Jntamty at Preg-uaiicy, Puerperal Insunily, aiid Insanity uf Lactatit
■-y Dr. J. B. Take.

■^

THE CAUSATION AND PEEVESTION OF INSANITV. 21l|

Theeai'liestcffect of sympatlietio morbid action will be, as with
vitiated blood, a modification of the tow of nei-ve element, which
ia manifest functionally in disordered emotion. But the con-
tinued operation of the morbid cause will lead to a systematized
diaorder in the supreme cerebral centres : in other words, to the
production of a delusion or of a definite derangement of thought,
which then perhaps betrays a distinct relation to the primary
morbid cause. When, for example, a woman with morbid irri-
tation of the sexual organs has salacious delusions, believing
herself to be violated night after night, or with uterine or
ovarian disease beHeves herself with child by the Holy Ghost
or other supernatural means, the secondary derangement of the
cerebral centres testifies to the special eifect of the particular
diseased organ, as well in the ideational as in the affective
derangement; the delusive interpretation of the disordered
action, when it forces itself into consciousness, witnesses to the
nature of the primary morbid cause. Dr. Wright ' has published
the particulars of a case of cancer of the ovaries, uterus, and
omeiitum in which the afQicted woman had horrible delusions
that spirits, who gained entrance into her body, were tearing her
entrails, and that unknown persons violated her person during
the night ; and Dr. Skae mentions another case of a woman
who complained piteously for many months that she was re-
peatedly violated every night thi'ough the rectum, and in whose
body, after death, extensive cancer of the rectum was found. He
proposed to make a special group of the cases of iusanity asso-
ciated with ovarian and uterine disease; one of the most common
symptoms presented by thera being sexual JiaUucinaiion.

There is the most perfect harmony, the most intimate con-
nection or sympathy, between the different organs of the body
as the expression of its organic life, a unity of the organism
beneath consciousness ; it is a connection which, as Hunter
said, might be called a species of intelligence, and the brain
is quite aware that the body has a liver or a stomach, and
feels the effects of disorder in any one of the organs, without
declaring in consciousneea the cause of what it feels. This
^conscious but important cerebral activity, which ia the

4

B conscious but important cerebral activity, winch 13 the ^h
^ EeHiiburgh MixUcat Journal, laiV. ^^M

k

PATHOLOGY OF MIND, [iB

expresGion of the organic sjnipathiea of the brain, cannot fail,
when rightly apprehended, to teach the lesson, that every
organic motion, visible or invisible, sensible or insensible,
ministrant to tJie noblest or to the humblest uses, does not pass
away issueless, but has its due effect upon the whole, and thrills
throughout the most complex recesses of the mental life,*

It often happens that no information is given by this apecios
of organic intelligence until the primary and secondary mischief
is far advanced, and it is then only given indirectly in language
which must be interpreted by the light of pathological know-
ledge ; for while there is entire unconsciousness of the primary
disease in the distant organ, and an entire unconsciousness of
the secondary morbid action in the brain, the effect may never-
theless be positively attested hy melancholia, delusion, or some
other form of mental disorder. Esquirol graphically tells
the story of a woman who thought she bad in her belly the
whole tribe of apostles, prophets, and martyrs, and who, when
her pains were more than usual, railed at ihem for their greater
activity. After death lier intestines were found glued together
by a chronic peritonitis. I have seen a patient suffering from
chroiuc insanity who fancied that he had got a man in his
inside, and who, when Ms bowels got much constipated, as they
were apt to do, made the most desperate attempts, hy vomiting
and otherwise, to get rid of Mm. After a purgative, however,
he was quite comfortable for a time, and his delusion subsided
into the background,* In the insanity which occurs in connec-

Full uE prciportion one limb to anutlicr, ^^H

And all to all the world besides, ^^|

Each part calls the further brother. ^^|

For head with foot hath private (tmity, ^^|

And bolh with moon and tides."— G euros Herdeht.
' In the Leicester BBylum was a mnle patient who had been there for
moiTiy years, and who bad been in the habit of stating that there was a
hundred we igtit of iron in hia abdomen; lie would occaaionally put his
hands to his abdomen, as if to support the weight of meful which ha
believed to be there; it was impossible in any way to shake his rooted
delusion. He Buffered from meUncholia, wna often very reticent, and
never communicative, Some time before bis death he wns observed not
to take his food so well ns usunl : he more frequnnlly pressed his hands
against his abdotiien ; and when stnnding bo leniied slightly forward ; but

V.J THE CAUSATION AND PREVENTION OF INSANITY. 213

tion with phthisis, appearing about the same time and goii^
along with it, there are often delusions of suspicion which
appear to have their foundation in the anomalous feelings
incident to the advance of the tubercle : one such patient under
my care fancied that he was maliciously played upon by secret
fire, misinterpreting in this way the actual increase of bodily
temperature or the perversion of sensibility which he felt; he
also imagined that a filthy disease had been produced in his
mouth, the delusion probably having its origin in the perversion
of smell or of taste resulting from the disease. Not only is the
remote pathological effect of a diseased organ thus revealed
mentally by the development of some form of insanity, but, as
already pointed out, a special effect of the particular morbid
organ is sometimes manifest in the character of the delusion
which is formed. It is by virtue of this kind of sympathetic
action that a person has dreamed sometimes that he had a
particular internal disease, and the dream has turned out to be
prophetic. The recurrence of a certain mood of mind, or of
exactly the same train of thought and feeling, or of the same
hallucination, before an outbreak of recurrent insanity or of
epileptic fits, such as has uniformly gone before former attacks,
and the revival of particular morbid ideas, feelings, and desires
during the insane paroxysm, may be, and probably often are,
owing to a periodical revival of the morbid irritation in the
distant organ. In those women whose mental dispositions are
much affected sympathetically at the menstrual periods, the
same sort of feelings, susceptibilities, caprices, and fancies
notably recur. There is indeed good reason to believe that the

he never even once complained of pain or other uneasiness. He was per-
suaded to go to bed. Afterwards the symptoms increased in severity : the
abdomen became very tender on pressure, the appetite failed, the pulse
became weak and thready. During the whole of his illness he was very
silent and uncommunicative, so that no information could bo obtained by
asking him questions. He died a few days after taking to bed, and a post-
mortem examination revealed a perforation of the intestine, near the
junction of the ascending and transverse colon, sufficiently large to admit
the tip of the little finger. Through this opening some of tlie liquid fasces
had passed into the peritoneal cavity. There were signs of inflammatory
action in the neighbourhood of, and for some distance around, the aperture,
but not to the extent which might have been expected. The gradually
perforating ulcer was probably the occasion of Ivlii d.^\\fi\QW.

214 PATHOLOGY OF MIND. [cuap.

brain retains something of the impressions received from the
organic life, even when they are morbid; and though it may
forget them in its normal state they will be revived when the
morbid state of the organ recurs, just as the experience of a
dream >vhich has been forgotten in the waking state may be
remembered in a subsequent dream.

The disorder of an internal organ of the body notably pro-
duces in all persons some affection of the mood of mind — in
some more, in some less ; but when it goes beyond affective
disturbance to produce actual derangement of intellect, we are
constrained to assume an individual predisposition to such de-
rangement, inasmuch as it has not such effect in all cases ; and
this we commonly find when we make proper inquiries. But
what I would have particularly noticed here is that when persons
have what is called a sensitive or susceptible nervous tempera-
ment, it is not merely that they are more powerfully affected in
mind and body by external impressions, but that the physio-
logical sympathy of their bodily organs is more acute and direct,
whereby these answer more easily and more actively to one
another's sufferings. The idiosyncrasy of a person means not
his nervous constitution only as a separate thing, but the whole
temperament of his body, in which every part is knit together
in the closest unison, the least element being felt in the whole
and the whole in each element. He may have no special pre-
disposition to insanity or to any other nervous disorder, and yet,
by virtue of the intensity of his intrinsic organic sympathies,
declaring themselves in the functions of his nervous system as
the gi-eat co-ordinating mechanism of the body and in the
mental organization as the crown thereof, he may be prone to
suffer seriously in mind from disorders of internal organs which
another person would feel to be hardly more than inconveni-
ences. For the same reason, when actual derangement of mind
exists the disorder of the internal organ will colour the symp-
toms more strongly in one person than in another. The philo-
sophy which enables one to bear an abdominal trouble patiently
may not suffice to do the same service for another, although he
exercises as much of it, because of his more acute organic sym-
•^athies. Too close and direct a relation of dependence between

i

THE CAUSATION AND PEEYENTION OF INSANITY.

the parts and the supreme authority is probably an ill thinj
in the bodily, as in the political, organism.

Between the organic feelings just considered — the viial penseBf I
as they are sometimes called — and the lower special senses, th^B
closest relations exist; ia truth, they run insensibly into onelf
another, as the skin covering the outside and the mucous n
brane linuig the inside of the body do. Thus the digestive
organs have the closest sympathy with the senses of taste and
siuell, as we observe in the bad taste accompanying indigestion,
and especially perhaps in the avoidauce of poisonous matters by
animals; the respiratory oi^ns and the sense of smell are in
like manner intimately associated ; and the sense of touch has
close relations with the ccenjesthesis. In insanity these physio-
logical sympatliies become the occasions or the food of delusions :
derangement of the digestive organs, perverting the taste, gives
rise to the delusion that the food is poisoned; disease in the
respiratory oi'gans is sometimes the cause of disagreeable sub-
jective smells, which are thereupon attributed to an objective
cause, such as the presence of offensive emanations or of a dead
body in the room ; and more or less loss or perversion of sensi-
bility in the skin, which is not uncommon amongst the insane,
is tlie frequent occasion of extravagant delusions. A woman
whose case EscLiiirol relates, had complete anresthesia of the
surface of the skin : she believed that the devil had carried off
her body. A soldier who was severely wounded at the battle
of Aust^rlitz considered himself dead from that time: if he
were asked how he was, he invariably replied, that "Lambert
no longer lives; a cannon-ball carried him away at Austerlitz.
What you see here is not Lambert, but a badly imitated machine,"
— which he failed not to speak of as it. The sensibility of liis
skin was lost^

L In the same way motor hallucinations occur. A striking
^stance of delusion in connection with defective sensibility
and loss of motor power occurred in an amiable and genial
patient who was once under my care, sufTering from general
paralysis. As tlie disease approached its end, the end of life,
had severe epileptiform convulsions, which latterly affected
left side only, and were followed b'j ■^o.tsX'^sv?. "A '^ta.'^S-

I

I «6 PATHOLOGY OF MIND. [nitp.

side. Biit although the power of inovement and feeling M-eie
entirely gone, there were fi'Gquent spostnoilic twitcliinga of the
muscles, and sometimes convulsive contractions so strong as
to raise the arm and leg of the paralyzed siJe from the bed.
The poor man had the most singular delusions respecting these
movementa : he thought that another patient, who was perfectly
demented and harmless, had got hold of him and was torment-
ing him, and accordingly, without real anger, but with an
energy of language that was habitual to liini, he thus solilo-
quized aloud : — " What a power that damned fellow has over
me ! " Then after a convulsive paroxysm, — " He has got me
round the neck, and you dare not touch him, not one of you.
Oh ! but it is a burning shame to let a poor fellow be murdered
in this way in a public institution. It's that boy does this to
me." Told that he was mistaken, he replied, — " You may as
well call me a liar at once : he has got me round the neck and
he has me tight. Oh ! it is a damned shame to treat me in this
■way — the quietest man in the house." Then after a while, —
" It's a strange power these lunatics have over one. That boy
is playing the devil with me : he stitiks worse than a polecat :
he'll take my life, sure enough." And so on continually, until
the stupor of death overpowered him.

Laudably anxious lo give due weight to the perversions of
sensibility which are met with in insanity, Griesinger made
five groups of mental disorder connected with different anoma-
lies of sensibility, and more frequently than not, he thought,
actually dependent upon them. The first of these is the pre-
cordial form, where there are morbid seusntions, sense of pres-
sure, or of constriction, or of coldness, or of fluttering, or of
actual pain about the epigastrium, upon which follow fear
and mental anguish, with corresponding ideas and habits of
tliought; it is a disorder of sensibility which is common enough
in some forms of apprehensive and hypochondriacal melan-
cholia, and is often accompanied by an extraordinary alarm
and helplessness. The seeon<i is the vertiginmis form-, in which
some anomaly of muscular sensibility exists. In the third,
which lie calls the parwstlieticat form, there are anomalous
tions in diflerent parts of the body, aUributcd by the

v.] THE CAUSATION AND PREVENTION OF INSANITY. 217

patients commonly to external . machinations. The fourth is
the anoBsthetic fomiy in which absence of sensibility is often the
cause of «elf-mutilation. Lastly, there is the hallucinatory form,
which obviously needs no further explanation here. It is un-
doubtedly of great importance to bestow scrupulous attention
upon all the disorders of sensibility, as well as upon those of
nutrition and movement, which occur in the different sorts of
insanity ; to do so is an essential part of the physician's duty in
studying the entire natural history of the disease ; but it is not
possible to make perversions of sensibility alone the basis of a
system of classification. Such a classification could not fail to
have an extremely artificial character and an entirely theoretical
foundation.

The centre of morbid irritation which gives rise to secondary
disorder by reflex or sympathetic action need not be in some
distant organ; it may be in the brain itself. A tumour, an
abscess, a clot of blood, a cysticercus, a local softening in the
brain, will nowise interfere with the mental operations at one
time, when it produces grave disorder of them at another time ;
and it is not uncommon in abscess of the brain for the symptoms
of mental derangement, when there are any, to disappear entirely
for a time, and then to return suddenly in all their gravity.
^A^^hen the motor, sensory, and ideational centres are not directly
damaged by the disease, they can continu^e their functions in
spite of it ; accordingly they sometimes do so even when there is
the most serious mischief going on in the brain ; but they may
at any moment be affected by a sympathetic or reflex action, and
a secondary derangement or abolition of function may thus
supervene without warning, the gravest symptoms perhaps
coming and going in a surprising mannerrj Instances now and
then occur in which a sudden loss of consciousness, or a sudden
incoherence, or sudden mania, or even sudden death, takes place
where no marked premonitory symptoms have indicated grave
local disease of the brain.

Furthermore, a limited disorder of the ideational centres, such
as is manifest functionally in the fixed delusions of the so-called
monomaniac, is not usually without effect upon the other
elements in the supreme centres. So delic^t'A^ ^-^\si"^^^5»!^^^^«

218 PATHOLOGY OF MIND. [cnAP.

and sensitive as nerve-element is, it is not probable tbat a centre
of morbid action will fail to affect, by direct or by reflex action,
neighbouring parts that are not immediately involved in the
disease. In matter of fact a greater or less disturbance of the
tone of the whole mind does commonly accompany the limited
delusions of a so-called pai*tial insanity ; the condition of things
is something like that which has already been described as the
first stage of the affection of mind by other causes of its derange-
ment— ^namely, a modification of the mental tone. This baneful
effect of a limited local disorder is not of course a case of meta-
stasis, since the primary disease disappears not, but a case of so-
called sympathy, where the primary disease continues in action;
in other words, it is produced by direct or reflex irritation.
Hereafter we shall have occasion to describe instances of the
sudden and entire transference of active disorder of one nervous
centre to another ; for, as Dr. Darwin long ago observed, *' in
some convulsive diseases a delirium or insanity supervenes and
the convulsions cease; and, conversely, the convulsions shall
supervene and the delirium cease."

It is necessary here, as in the spinal, sensory, and motor
centres, to distinguish between the degrees of secondary disorder
to which a distant morbid cause may give rise. The sudden
way in which extreme mental symptoms appear, and the equally
sudden way in which they disappear sometimes, as in abscess of
the brain, prove that extreme derangement may be what is
called functional ; for it is impossible to suppose that serious
organic change has been and gone in such cases. Although,
therefore, the functional disorder necessarily implies a molecular
change of some kind in the nervous element, the change may be
assumed to be one affecting the polar relations of the molecules,
such as the experiments of Du Bois Eeymond and others have
proved may rapidly be induced and as rapidly disappear. Cer-
tainly the induction of recognizable temporaiy changes in the
pliysical constitution and function by experiments, warrants the
belief in similar modifications by causes which are not artificial,
but which are just as abnormal as if they were. If the modifi-
cation of nervous element be too great or too prolonged, it fails
not to degenerate into actual nutritive change and structural

v.] THE CAUSATION AND PREVENTION OP INSANITY. 219

disease, just as an emotion which alters a secretion temporarily
may, when long enduring, lead to actual nutritive change in the
organ. The longer a functional derangement lasts, the more
danger is there of structural disease ; and when this serious
change is once definitely established, the removal of the primary
morbid cause will not get rid of an effect which has now become
an independently acting cause.

4. Excessive Functional Activity, — As the display of function
is the consumption of matter, it is obvious that, if the due inter-
vals of periodical rest be not allowed for the restoration of the
statical equilibrium of nerve-element, degeneration of it must
take place as surely as if it were directly injured by a morbid
poison, or by a mechanical or chemical irritant. It is sleep
which thus knits up the ravelled structure of nerve-element ;
for during sleep organic assimilation restores, as statical or
potential, the power which has been expended in functional
energy. The brain, like any other organ of the body, is endowed
with a limited power of work and endurance only, a limit which
cannot be exceeded without danger ; and its strength and weak-
ness measure the strength and weakness of the mind. The
strongest mind, if continually overstrained, will inevitably break
down ; one of the first symptoms that foreshadows the coming
mischief being sleeplessness. That which should heal the breach
is rendered impossible by the extent of the breach. Like Ham-
let, according to Polonius's fruitful imagination, the individual
falls into a sadness, thence into a watch, thence into a lightness,
and, by this declension, into the madness wherein he finally
raves. To provoke repose in him is the first condition of re-
storation ; sound sleep closing the " eye of anguish," and curing
the " great breach in the abused nature " of nervous element.

It is, however, when intellectual activity is accompanied with
great emotional agitation that it is most enervating — when the
mind is the theatre of contending passions that its energy is
soonest exhausted. The instability of nerve-element which
great emotional susceptibility means enables us to understand
how this destructive effect is wrought. When an exceedingly
painful event produces great sorrow, or a critical event great
agitation, or an uncertain event great apprehensioia. ^wd ^jck^^X^j ^

PATHOLOGY OP M!NU.

IS not M I

^^m spat

tlie mind is undergoing a passion orsufTering; there is not i
equilibrium between the internal slate and the external circuni-
staucea ; and until the mind ia able to react adequately, either
in consequence of a fortunate lessening of the outward pressure,
or by a recruiting of its own internal forces, the passion must
continue — in other words, the wear and tear of nervous element
must go on. Painful emotion is iu truth psychical pain; and
■pain here, as elsewhere, is the outcry of auilVring organic element
—a prayer for deliverance and rest.

The same objects or events notably produce very different
impressions upon the mind according to ita condition at the
time — according perhaps as something pleasant or something
■unpleasant has just happened. If there be a temporary depres-
sion of the psychical tone by reason of some recent misfortune,
or because of same bodily derangement, then an event, which
under better auspices would have been indifferent, will rouse
painful emotion, and, calling up congenial ideas of a gloomy
kind, perpetuate and add to the mental suffering; just as
TellcK action that is provoked or increased by a morbid cause
sometimes aggravates in turn the original disorder. If there
.'be a lasting depression of the psychical tone by reason of
i«ome continuing morbid cause, then every event is apt to ag-
the suffering, being seen through the distorting medium
of the sad feeling; and a particularly unfavourable event, or a
succession of painful events, may be enough to cause actual
derangement of mind. After a piece of good news, or after a
man has just drunk a glass of wine, or taken a dose of opium,
the psychical tone is so much animated that there is a direct
and adequate reaction to an unfavourable impression, aud he will
not suffer; wherefore comes the temptation to have recourse in
time of trouble to stimulants like opium and alcohol Herein
the supreme centres of thought do not differ from tbe inferior
nervous centres; when the spinal centres are exhausted, ex-
citability is increased, a state of irritable weakness being pro-
duced, and an impression, which under hetter auspices would
have had no bad effect, gives rise to tbe degenerate activity of
spasmodic movements : an explosion not unlike that which in
higher centre is manifest as emotion, or as an ebullilion of

22|H

f] THE CAUSATION AND PREVENTION OF INSANITY.

passion, since emotional outLursts uiny justly ba considered to b
of the nature of molecular explosions or commotions. Excess is,
however, a relative term; and a stress of function which wouk'
be no more than normal to a powerful and well-ordered mind,
and conducive to its health, might be fatal to the stability of a
feeble and ill-regulated mind in which feeling habitually over-
swayed reason, or even to that of a strong mind which was
temporarily prostrate. Thua it is that in pursuing inquiries
into the causation of insanity in any case it is not enough to
examine only the concurrence and succession of influences to
which the individual has been exposed, but it is necessary also
to look to the capacity he had of bearing them at the time.

In weighing the operation of mora! causes to produce insanity
we find too their effect to be in proportion to the suddenness
and intensity with which they strike as well as to their actual
power; for a sudden shock, like a violently imposed burden, will
break down the strength when a heavier burden would have
been borne had it been adjusted gradually. The violence of tbo
shock is determined by the suddenness and weight of the moral
impression— by the momentum, in fact, with which it strikes the
mind. In the same way, the lavish expenditure of a great deal
of energy in a short time, such as takes place in a financial
crisis, in a political revolution, in a religious revival, and on
similar occasions of agitation of feeling and exaltation of energy,
when the whole power of the mind is stimidated unduly and
u-sed unsparingly within a brief period, will be followed by a
deep exhaustion that may end in disease ; notwithstanding that
the same amount of energy might have been used without grave
danger if its expenditure had been prudently regulated. A per-
son should deal with his vital force very much as he deals with
his linances, and live on the interest of his capita! ; for should
he make demands on the capital^ whether in a large sum to meet
an occasional emergency, or in accumulating dribblets to meet
daily slight excesses of expenditure over income, he must bo
bankrupt in the end.

I tate the actual mode of operation of a moral cause to ba
just as physical as the operation of a stroke of lightning, which,

:e it, may produce paralysis or sudden death, awl ^j^tV'ji.'^ \-».

2I2S2 PATHOLOGY OF MIND. [chap.

tlie same way ; and I look upon the derangement of mind which
grief causes as just as much a physical result brought about by
physical causes as is the delirium of starvation. When any
great passion causes all the physical and moral troubles which
it will cause, what I conceive to happen is that a pliysical im-
pression made upon the sense of sight or of hearing is propa-
gated along a physical path to the brain, and arouses a physical
commotion in its molecules ; that from this centre of commotion
the liberated energy is propagated by physical paths to other
parts of the brain ; and that it is finally discharged outwardly
through proper physical paths, either in movements or in modi-
fications of secretion and nutrition. The passion that is felt is
the subjective side of the cerebral commotion — its motion out
from the physical basis, as it were (e-motion), into consciousness
— and it is only felt as it is felt by virtue of the constitution of
the cerebral centres, into which have been wrought the social
sympathies of successive ages of men : inheriting the accu-
mulated results of the experiences of countless generations, the
centres manifest the kind of function which is embodied in
their structure. The molecular commotion of the structure is
the liberation of the function: if forefathers have habitually
felt, and thought, and done unwisely, the structure will be
unstable and its function irregular.

The foregoing reflections show that, from a pathological point
of view, the so-called moral causes of insanity fall fitly under
the head of excessive stimulation or excessive functional action :
the mind is subject to a stress beyond that which it is able
to bear, either because of the weight of the pressure from with-
out or because of the weakness within. Of necessity the
depressing passions are the most efficient causes of exhaustion
and consequent disease : grief, religious anxiety, loss of fortune,
disappointed aflfection or ambition, the wounds of an exaggerated
self-love, and, above all perhaps, the painful feeling of bein<»
unequal to responsibilities, or other like conditions of mental
agitation and suff'ering, are most apt to reach a violence of action
which issues in the overthrow of the mental equilibrium. Great
intellectual activity, when unaccompanied by emotion, does not
often lead to insanity ; it is when the feelings are anxiously

v.] THE CAUSATION AND PREVENTION OF INSANITY. 223

engaged that the mind is most moved and its stability most
endangered : on the stage of mind as on the world's stage the
great catastrophes are produced by passion. Moreover, when an
individual has, by a long concentratioA of thought, interest, and
desire upon a certain aim, grown into definite relations with
regard to it, and made it, as it were, a part of the inner life, a
sudden and entire change, shattering long-cherished hopes, is
not unlikely to produce insanity ; for nothing is more fraught
with danger to the stability of the mind than a sudden great
change in external circumstances, without the inner life having
been gradually adapted thereto. Thence it comes that a great
exaltation of fortune, as well as a great affliction, rarely fails to
disturb for a time the strongest head, and sometimes quite over-
turns a weak one; the former succeeding after a time in
establishing an equilibrium between itself and its new sur-
roundings which the latter cannot do. When exhausting
passion does not act directly as the cause of a sudden outbreak
of insanity, it may still act banefully by its long-continued
depressing influence on the organic life, and thus in the end
lead to mental derangement.

Automatic function I have shown to mean stored-up power
— abstract of former function — inherent as original faculty of
the individual or acquired by his own cultivation and exercise.
Whether then he shall be equal to the work and responsibilities
of his position in life will depend, first and mainly, upon his
native powers of mind, and, secondly, upon the special training
w^hich he has had to fit him for what he has to do : either will
supplement in large measure the deficiencies of the other.
Accustomed duties are discharged with ease, while new duties
exact much expenditure of anxious energy, because the special
automatic power has to be built up by laborious training in
accordance with a law of structuralization of function. It is
easy then to see why the assumption of important new func-
tions for which the individual is not fitted by original power or
by previous special training will be especially trying to his
mental stability : there is not only a large call upon cerebral
energy to make the adaptation, but there is the exhausting
emotion produced by the nervous appreheuaiow ot \jX!L^\.\^fc^^.

I

i

PATHOLOGY OF MIND.

Here is made manifest the wisdom of a sound general cu]
by which tlie mind ia made a iitling instrument to adapt i
easily to any form of special activity ; if a person make it 1|
pains to have good habit of judgment, good habit of tliought,
good habit of feeling, good habit of doing, by continual practice
of good judgment, good thouglit, good feeling and good doing,
80 that he needs not on each new occasion to consider minutely,
to feel apprehensively, to do anxiously, but can judge, think,
feel, and do quickly and, as it were, instinctively, he will have
an excellent stability of nature to enable him to cope with the
duties and trials of his life in whatsoever position he may be
placed.

Another class of moral causes of insanity acts quite differently
from the depressing causes which I have just considered: these
are the elated passions. It is not often that men become insane,
though they sometimes die, from the commotion which excess
of joy occasions ; and wlien one of the expansive passions, aa
ambition, religious exaltation, overweening vanity in any of its
Protean forms, leads gi-adually to mental derangement, it does
not, like a painful passion, act directly as the cause of an out-
break, nor indirectly by producing oi^anic disorder and snb-
Bequent insanity ; its morbid effects are the exaggerated develop-
ment of a certain peculiarity or vice of character — the morbid
hypertrophy, so to epeak, of a bad quality of cbaractor. Each
indulgence in passion, caprice, even oddity or perversity, notably
makes easier the next step in the same direction : what a person
sows hourly, good or ill, that shall lie reap : the hypertrophy of
jiassion and prejudice is the atrophy of principle and judgment.
In the Edinburgh asylum was a blacksmith who imagined him-
self to be King of Scotland ; his daughter, who was an inmate
of the same asylum, believed herself to be a royal, princess ;
not because she shared her father's delusion, for she perceived
clearly enough tiiat he, poor man, was only a blacksmith who
had an insane delusion, as he also on his part recognized that his
daughter was not a princess, but a lunatic. The daughter's delu-
sion then was not a specific inheritance by her nor had she got
it by logical inference ; it was probably the morbid outgrowth
of a fundamental quality of character common to her and to her

I

THB CAUSATION AND PREVENTION OF INSANITT.

father. It ia tliis development of insanity as the morbid growth
of a disposition which often makes it hard to eay where disease
begins, and harder still to cure it "When a depressing passion
due to external causes overthrows the mind, the derangement
ia, so to speak, accidental or extrinsic, and the delusion which ia
the outgrowth of it fades and finally vanishes as the emotional
tone improves and mental power is restored ; when an egoistic
passion grows into a morbid delusion, the derangement is
essential or intrinsic, and the delusion which ia its essential
outcome citnnot be got rid of except by rooting out the dis-
position : it is not an instance of excessive functional activity,-
but an instance of morbid development.

A fatal drain upon the vitality of the higher nervous centres
ia in certain cases the consequence of the excessive exercise of
a physical function — an excessive sexual indulgence, or a habit
of self-abuse. Nothing is more plain than that either of these
causes will produce an enervation of nerve element which, if
the exhausting vice be continued, passes by a further declension
into degeneration and actual destruction thereof. The flying
pains and the startings of tlie limbs, which follow an occasional
sexual excess, are signs of instability of nerve element in the
spinal centres, which, if the cause is in frequent operation, may
end in softening of the cord and conaec^uent paralysis. Nor do
the supremo centres always escape; the habit of self-abuse
notably gives rise to a particular and disagreeable form of ^^m
insanity, characterized by intense self-feeling and conceit, losa ^^H
of mental energy, hypochondriacal brooding, pitiful vacillation, ^^H
extreme perversion of feeling, and corresponding derangement ^^
of thought, in the earlier stages; and, later, by failure of in-
telligence, nocturnal hallucinations of a painful character, and
suicidal or homicidal propensities. The mental symptoms of
general paralysis — a disease often caused by sexual excess —
/betray a degenerate condition of nerve element in the higher
centres, which is the counterpart of that which in the lower
centres is the cause of tJie loss of co-ordination of movement
and of more or less spasm or paralysis. The great emotional
^—exaltation, the busy excitability with feebleness, of the general ^^
^■Htaralytic, no less tliiiu the extravagiiuce o( Viis \4eaa, \■ii'a.'^f- ^^H

I

226 PATHOLOGY OF MIND. [chap.

degeneration of the ideational centres ; there is accordingly an
inability to co-ordinate and perform his ideas successfully even
before there are actual delusions, just as there is an inability
to perform movements successfully in the later stages of the
disease, because the spinal centres are similarly affected. It is
not usual, however, for sexual excesses to cauge other sorts
of insanity than general paralysis ; their tendency is to produce
epilepsy or some form of paralysis. Self-abuse is a cause of
insanity which appears to be more frequent or more effective
in men than in women, and in them to require usually the
co-operation of a particular neurosis. Apart from all question
whether the vice be so common among women, they bear its
effects, as they do sexual excesses, better than men. On the
other hand, privation of sexual function is more injurious to
women than to mea
/ ^ 5. Injuries and Diseases of Vie Brain and Nervous System not
necessarily, hut occasionally , producing Insanity.-C-lniuTies of the
head, when not followed by immediate ill consequences, may
nevertheless lead to mental derangement, through the degenera-
tive changes which they ultimately set going in the cortical
layers of the hemispheres.^ The changes are often of a slow
and insidious character, going on for years perhaps before they
produce very marked mental effects. At first there is nothing
more noticed than a change of temper and disposition in the
person ; he is prone to outbursts of anger on trivial occasions, or
to excesses foreign to his former character ; a moderate quantity

1 Professor Scblager, of Vienna (Zciischrlft der h. h GesetlscTiaft dcr
Aerzte zu Wien, xiii. 1857), has made some valuable researches regarding
mental disorder following injury of the brain. Out of 500 insane, he
traced mental disorder to injury of the brain in 49 (42 men and 7 women).
In 21 cases there hid been complete unconsciousness after the accident ;
4n 16, some insensibility and confusion of ideas ; in 12, simple dull head-
/nche. In 19 cases the mental disorder came on in the course of a year
after the injury, but not till much later in many others, and in 4 cases after
^more than ten years. In most of the cases the patients were disposed to con-
gestion of the brain, excitement and great emotional disturbance, from the
time of the injury, on taking a moderate quantity of spirituous liquor ;
frequently there was singing in the ears, or difficulty of hearing, or hal-
lucination; and very commonly the disposition was chanp^ed, and the
patient was prone to outbursts of anger or of excesses. The prognosis
was very unfavourable ; the issue in 7 cases was dementia with paralysis,
wJjilc 10 went on to death from the progress of the brain disease.

w

THE CAUSATION AND PREVENTION OF IHSANITT.

of alcohol produces an extraordinary excitement, making him
perhaps not drunk, but actually mad for the time being, so that
he may get into trouble for assault or other breach of the law.
Years aometimea pass before graver symptoms show themselves.
Dr. Skae mentions the case of a woman who, having suffered a
fractui-e of tlie skull, evinced a change in temper and disposition
afterwards and somo other symptoraa which were referred to the '
accident, and wiio, after twenty yeara, became insane and violent.O
An outbreak of acute mania, or an epileptic fit followed by^
mania, may be the cUmax of a long aeries of slow changes, and
be followed by gloomy depression with suspicious delusions and g»*
iinpulaive violence, and by increasing dementia, ^

[a most interesting case has been put on record by Dr. Holland
Skae.^ A collier was struck insensible by a mass of falling coal
which fractured his skull about three inches above the outer angle
of the left eyelid. Afferfour days he regained consciousness, and
iu a few weeks was able to resume work in the pit. Soon after
doing so a change was noticed in his diameter and beliaviour :
instead of being, an formerly, cheerful, sociable, good-natured,
gentle to wife and children, he was moody, taciturn, and irritable,
repelling the attentions of his wife's and the demonstrations of
Lia children's affection. Gradually he got worse ; he was often
excited, used threatening language to his wife, children, and
neighbours ; finally he became nianiacal and violent, attempted
to take his own life and his wife's hfe, and had a succession of
epileptic fits. He was sent to au asylum. After he had been
tliere two months he was trepliined, a depressed portion of bono
at the place where he had been etruck being removed. Soon
after the opei-ation he began to mend, returning gradually to his
natural self; in the end he became a clieerful, active, and oblig-
ing person, with all his family affections restored. He was able
to support bis wife and family by his labour when he left the -^
asylum, and four years after his discharge 'waa still quite sane. vK_J

Insolation notably acts injuriously on the supreme cerebral

centres, either by causing, as some imagine, acute hj'periemia

and serous effusion, or, as is more probable, over-stimnlation

^^H ' ReportofihfMomingsidBAi'yluvi, 1867. ^^d

^^^^p * Journal qf Mental Science, vol. xix., p. £52. -^^^^^

I aud (

PATHOLOGY OF MIND.

10^

I

aud consequent exliatistiou of nerve element. In most itistancea
of the kind there is reason to think tiiat an impmdent indul-
gence in alcoholic stiiuulanla has co-operated.

Hysteria uudouhtedly slides into itisauity in some instances.
There seem to be two varieties of mental derangement present-
inf" hysterical characters, which may, however, pass into one
nnother. An acuto attack of maniacal excitement, with great
restlessness; perversenesa of conduct, which is pretty coherent
and wilful; loud and rapid conversation, sometimes bla.ipltemou3
laughiiiy, singing, or rhyming — may follow the
m'dinary hysterical convulsions, or may occiir instead of them.
(3r the ordinary hysterical symptoms may pass hy degi'ees into
a chronic insanity : the patient loses more and more energy and
SL'lf-control; becomes more fanciful about her morbid sensations,
to which she gives exaggerated attentions; is extremely egotistic,

I wilful, atid exacting; gets more and more impatient of all ailvice
or interference, and indifferent to social obligations; and of ten-
limes shows a singular aptness for deceit The body becomes
anieinic and emaciated, and tliero are usually irregularities of
menstruation. An erotic element is sometimes evinced in the
manner and thoughts ; and occasionally ecstatic or quasi-cata-
leptic states occur. The symptoms are often worse at the
menstrual periods.
Under the head of nervous diseases which may become occa-
Biiins of insanity must be placed chorea and epilepsy, although
we know not yet what are their exact seats in the nervous
aystem. Chorea in the adult is not unapt to terminate in mental
disorder ; but it is not at all apt to do so in the child, although
some dulncss and weakness of mind often accompany it.
Diflerent sorts of insanity ai'e met with in connection with
epilepsy. When the fits have recurred frequently, and the
disease haa continued for a long lime, it undoubtedly produces
loss of memory, failure of mental power, and ultimately com-
plete dementia. That is one form. Secondly, a succession of
severe fits may be followed by a condition of acute dementia
which lasts foi' a short time, or by an acute, violent, and most
dangerous mania, which usually passes away in a few days.
Not only may acute niaiiia thiis follow epilepsy, but an attack

THE CAUSATION AND PREVENTION OF INSANITY.

of acute transitory mania — a tnie mania transi(oria — may take
the place of the epileptic paroxysm, being truly a masked
epilepsy. Some writers maintain, however, that in these cases
a brief attack of epileptic vertigo or petit mal has passed un-
observed. Lastly, ia some cases a pmfound moral disturbance
— an iiritability, moroseness, and perversion of character, lasting
for months, with periodical exacerbations in which vicious or
criminal acts may be perpetrated— precedes the appearance of
the regular epileptic fits, which then throw light upon the
hitherto unaccountable moral perversion. It is another phase
of a kind of abortive or undeveloped epilepsy,

flere I may fitly take occasion to adduce certain observations
with regard to the striking manner in which diseased action of
one nervous centre is sometimes transferred suddenly to another ;
a fact which, though it has lately attracted new attention, was
long since noticed and commented on by Dr. Uarwin : — " In
some convulsive diseases," he writes, " a delirium or insanity
supervenes, and the convulsions cease ; and, conversely, the
convulsions shall supervene, and the delirium cease, Of this
I have been a witness many times a day in the paroxysms of
violent epileptics ; which evinces that one kind of delirium is a
convulsion of the organs of eense, and that our ideas are the
motions of these organs." Miss G., one of his patients, a fair
young lady with light eyes and hair, was seized with most
violent convulsions of her limbs, with outrageous hiccough, and
most vehement efforts to vomiti After nearly an hour had
elapsed this tragedy ceased, and a calm, talkative delirium
supervened for about another h-our, and these relieved each
other at intervals during the gieater part of three or four daya
"After having carefully considered this disease," be says, "I
Uiought the convulsions of her ideas less dangerous than those
of her muscles ; " and thereupon he adopted such treatment as
resulted in the young lady's recovery. In another case which
came under hia observation, " these period.s of convulsions, first
of the muscles and then of the ideas, returned twice a day for
several weeks," " Mrs. C," again, " was seized every day, about
the Enme hour, with violent pains in the right side of her bowels,
about the situation of the lower edge of Wvft \\nct, Vx'Cvnrs^

he^l
ed^H
les/H

f

230 PATHOLOGY OP MIND. [chap.

fever, which increased for an hour or two, till it became totally
intolerable. After violent screaming she fell into convulsions,
which terminated sometimes in fainting, with or without stertor,
as in common epilepsy; at other times a temporary insanity super-
vened, which continued about half an hour, and the fit ceased.*'^

Brodie relates the case of a lady who suffered for a year
from persistent spasmodic contraction of the eterno-cleido-mas-
toid ; suddenly it ceased, and she fell into a melancholy ; this
lasted a year; after which she recovered mentally, but the
cramp of the muscle returned, and lasted for many years. In
another case mentioned by him, a neuralgic condition of the
vertebral column alternated with true insanity. Dr. Burrows
met with similar cases : one " in a very eloquent divine, who
was always maniacal when free from pains in the spine, and
sane when the pains returned to that site." ^ A patient in St.
Mary's Hospital, who was convalescent from typhoid fever, had
hypersesthesia of the legs, which ceased when maniacal delirium
set in, but returned with great intensity when the delirium sub-
sided.* Without doubt the delirium, which was the outcome of
a disorder of the supreme centres, was the equivalent of the
hyperaesthesia which was the outcome of disorder of the sensory
centres. "Whether there is an actual transference of the morbid
action from one set of nerve-centres to another in these cases ;
or whether an independently lighted disorder in the latter over-
powers and suspends the disorder of the former, as a greater
pain inhibits a less pain, or as an attack of mania sometimes
suspends an asthma or a chronic discharge, it is not easy to say.
We must accept the fact, whatever may be its exact pathological
explanation.

One of the most frequent observations which the clinical
observer has to make in respect of tumours, abscess, cysticercus,
and such gross products of cerebral disease, is the absence of
symptoms of mental disturbance. The fact at first seems
striking, because the presence of so much disease in its midst
might be thought incompatible with the undisturbed function of
the brain as the organ of mind. After giving a careful report

1 Zoonomia, vol. i. pp. 25, 26. ^ Commentaries on Insanity,

' Dr Haiidfield Jones in St, George's Hospital Eeport, vol. ii. 1867.

^^^] THE CAUSATION AND PREVENTION OF INSANITY. 231. ^H

of ten cases of tumour of the brain, Dr. Ogle calls attention to
the fact tliat, " in no case was there during life anything of the
nature of mental imbecility, or any symptom of the various ^^
phases or forma of insanity." ^ An examination of what was ^^^|
found after death in these cases furniahea a sufficient reason for ^^M
the non-affection of the intelligence. In none of the ten was ^^H
there any observed implication of the nervous centres of intal- ^^M
ligence by the morbid action; the mischief was more or Icbb ^^|
central, and the hemispherical ganglia continued their functions, ^^B
as they well might, in spite of it. If there is one thing which
pathological observation plainly teaches, it ia the slight irrita-
bility of the adult braiu; the gradual growth of a tumour
allows the brain to accommodate itself to the new conditions;
and a closely adjacent nervous centre may be entirely undis-
turbed in function until the morbid action .actually encroacbea
upon it. Not disease in the interior of the brain, but disease of
the membranes covering it and containing the blood-vessels
which go to the convolutions, is most likely to produce disorder
of the intelligence ; iu the latter case it lies close to the delicate
centres of intelligence, and seriously interferes with their supply
of blood. Whatever be the explanation, there can be no doubt
of the fact that a large tumour may exist in the brain, or "that
a considerable amount of the brain- substance may soften and
undergo purulent degeneration — the pus even becoming incap-
suled — without the presence of a single symptom to lead us to
suspect disease iu the brain.^ It haa even happened that a
patient in hospital, who haa complained only of langour, general
debility, and inability to exert himself, has been suspected of
feigning and accused of indolence because there were no markedi. ■
symptoms of disease, when a sudden and fLuick death haa J
proved at the same time the existence of an abscess 'of tha'l
brain and the injustice done to the sufferer.'

' Journal of Meiilal Science, July IBGi : Cases of Piimirj Carcii;
tlie Brain.

' For exnmplea of extensive injury to the brain, without mental di&-.J
tiirbance, see a paper by Dr. Ferriar in the first volume o£ the 2Ie7noiT» qff' J
the Literary and Philogophicat Socieljf of Manclitster. J

' Veber Geliiniabacctse, von Pro£ Dr. Lebert, Virchuw's ArcMv, voJ. StM
PM 186S.

^M III

PATUOLOGY OF MIND. [■ B

I

Certainly it eometimes liappens that mental disturbance goea
along with disease in the brain, even tfaongh the mischief is
quite central ; in that case we must tliink that the disease acts
aa a centre of irritation, and that the mind-centrea are affected
secoudarily; the disturbing action being either directly upon the
nerve elements, or indirectly upon them through direct vaso-
motor commotions. Two things will often be observed then
with regard to the mental symptoms ; — (1) that they are inter-
mittent, sq that they may disappear altogether for a while ; and
(2) that they have the character either of an incoherent
delirinm, or of greater or less mental imbecility.

(1) The entire disappearance of all symptoms of mental dis-
order for a time is evidence that they are not due to organic
structural change iu the nervous centres which directly minister
to mind ; for, if such change existed, the recovery could not be
80 sudden and complete. But if the disturbance of the cortical
cells is secondary, being a reflex effect of the primary morbid
action that is going on in the neighbourhood, it is easy to
conceive that it may come and go suddenly, just as epOeptifonn
convulsions, similarly excited, notably do. This is perhaps a
more probable explanation of the transitory disorder than the
supposition of vascular disturbances which come and go, alheit
these may be brought about by the mocbid irritation, and no
doubt play their part sometimes in producing the mental dis-
order. "Why a reflex pathological effect is produced in one case
and not in another, or why it is not permanent when once pro-
duced, we can no more say than we can say why an eccentne irri-
tation should sometimes give rise to convulsions or paralysis,
and sometimes not "What reason," asks Dr. Whytt, "can be
given why sometimes, after cutting off an arm or a leg, those
muaclos which raise the lower jaw should be affected with a
spasm, rather than other muscles ? "

(2) Not less consonant with the interpretation of the mental
disorder as a reflex effect is the character of it ; for it is manifest
mainly and mostly either in (a) great mental tnrpor or imbe-
cility, deepening into blank mindlessneas in the worst cases; or
(h) in delirium. That we do not usually meet with the recog-
nized forms of insanity is a fact of some interest and importance ;

H] THE CAUSATION AND PHEVENTION OF INSANITY. 233.^H

indicating, as it does, the cxistenco of diflerent morbid condi-
tions &om those of true insanity. A systematized mania or
melancholia represents a cerlain oi'ganized result of abnormal
character, a definite morbid action — the orgaiiization, if you will,
of disorder; the incoherent delirium, or the mental imbecility, t
with which we have now to do, iDdieates, on the other hand, a
general disturbance of the supreme centres of intelligence, with-'
out any systeraatization of the morbid actioa Hence, though
the delirium may be active, it is commonly extremely inco-
herent, exhibiting an entire absence of co-ordination ; it suggests
an agitation of the ganglionic centres of the hemispheres in
consecLuence of an irritation from without. So also with regard
to the imbecility when the mental disturbance ha3 that form : it
ia a general weakness without any definite character, wanting
the wrecks of systematic delusions which are usually met with
ill the dementia following mania or melancholia, I much doubt,
however, whether it ia possible ever to diagnose the disease
satisfactorily by its mental symptoms only : we must look rather
to such symptoms as intense paroxysmal headaches, giddiness,
afiections of one or other of the special senses, loss of power in
the muscles of the eye or of speech, optic neuritis, and finally

» epileptiform or apoplectiform attacks, and coma.
, When the local disease directly implicates the supreme centres
bf intelligence, there may be extreme mental disorder, or there
may not. When there is mental disorder it is not a litUe
remarkable how capriciously intermittent the symptoms some-
times are ; in fact, so strangely may they come and go, that one
runs no little risk of suspecting a patient of feigning them. At
one time he will assert that he ia blind, or that he is deaf, or
that he cannot walk, when it is plain at another time that he
sees, or hears, or walks well The following case illustrates well
the intermittcnee and the seemingly hysterical character of the
symptoms. A young lady aged sixteen, whom I saw two or three
times, complained of blindness, imperfect hearing, and loss of
power in the legs. Her father, a clever man of business, was
very excitable, and had had more than one attack of mania.
An aunt was peculiar, and her sisters were nervous and hysteri-
^L caL She hail been an unusually sharp, cunning, and ^c^cAoitsoib^J

TATUOLOGY OP MIND. [cJil

child, always very nauglity, destructive, and pleased to play
niiscliievous and malicious triclss. She menstraated at the age
f eleven, and had exhibited erotic tendencies and ideas, not
behaving with modesty in tlie company of her young brother,
and showing a knowledge of sexual matters which was sur-
prizing. She was expelled from acliool. At another school
to which she was sent her genorjl conduct was bad ; she was
extremely cunning and wilful, and at various times had hys-
terical fits of laughing and crying. One day, after being cor-
rected for bad conduct, she declared that she was blind, but the
Bchool mi stress and a medical mun who saw her thought she
vas malingering. In a lew days she recovered her sight. After
, time she declared i^ain that she was blind and deaf also,
remaining so for some weeks, when her hearing, but not her
Bight, returned, All the medical men who saw her thought she
was badly hysterical. Later on the deafness returned, and she
said she could not walk, her limbs being so weak. It was plain
that sometimes she could both see and hear. Then attacks of
excitement occurred from time to time in which she shouted,
laughed, cried, threw herself about, struck lier nurse; and at
last total blindness, deafness, and paralysis of the limbs were
indisputable. She complained of violent headache, became
wildly delirious, and died. After death a tumour, supposed to
be cancerous, about the size and shape of a hen's egg, was found
in the right hemisphere.

Another example; a young man, tot. twenty-four, suffered
from frequent and severe paroxysmal pains in the head,
CSS of vision, anxiety, extreme feehng of debility and
loss of power in the limbs ; there was also confusion of
thought. After a time he ha^ a maniacal attack ; saw balls
of fire falUng about him ; thought himself pursued by mon-
strous forms ; was very violent. The excitement lasted for
three days and nights without sleep, when he fell into a deep
eleep which lasted for twenty-four hours, awaking from it quite
conscious, with no remembrance of his previous excitement.
Again headache came on, with noise in the ears, and more or
leas paralysis of the voluntary muscles ; the maniacal excite-
ment recurred, becoming more continuous, and the paralysis

f ] TUE CAUSATION AND PREVENTION OF INSANITY. 23tfJ

md mental stupor increaseJ. One day he could neither stand
nor move his arma ; but after a tranquil night he could do hoth
quite ■well, and could return intelligent answers to questions.
In the evening he was again restless and excited ; after which
he became comatose and died. Numerona cysts of cysticercus
ceUolosua were found in the brain, five of them being fixed to
the inner surface of the dura mater and the rest dispersed
throughout tJie grey matter. By far the greater number were
found in the grey layers of the hemispheres, being collected
here and there into dense groups. lu another case, in which
twelve cysticerci were found after death in the brain, the
symptonis were those of gradually increasing dementia with
paralysis.

It is well known that a person may lose a part of his brain,
[ and yet not exhibit any mental deficiency or disorder. Indeed
L cases have been recorded which go to show that one hemisphere
I may do the work of the wliole brain ; the only apparent
I .tionsequGnce of the destruction of the other hemisphere being a
quicker exhaustion by exercise and perhaps a greater irrita-
bility. This heing so, it is easy to understand that a direct
encroachment upon the grey layers of the convolutions by

t disease may take place without causing mental derangement.'
Much has been written lately concerning a so-called syplulitic
insanity, hut syphiUtic products have no more special tendency
■wh
!■

B

The following case is reported bj Dr, A. Schworzenthnl in the Wiener

MedUinuchi Prissi lor August 20, 1871 r A woman, set. 30, a dny-laboiirer,

■who had previously heeii under treatment for syphilU and ieucorrhoea, was

idmitted to the bospitaJ in Znlkiew, Buffering with headache, wiikh was at

time at Beveral weeks' duration, with prostration and with diminution

ippetite. Febrile exBcerhations occurred sometimes in the inomiTig

Bometiines in the afternoon, nnd it was con»equent1; thnnglit tliat she

bitd intermittent fever. In time her condition had so much improved that

ehe was discharged. She returned to her occupation, doing as hard work

as before her illnese, and occasionally frequenting housea of ill repute, at

one of which she died suddenly a month after her disclmrge from the

hospital. The posterior Iialf of the ri^ht hemisphere of the bruin was

' ' ind converted into a large ahscess, while the left heroisphero wbh dougliy

the feel, and the cerebellum was softened. From the history of Ihe

itient. Dr. S, thought that tlie abscess of the hiain must have existed far

'' a, no twitli standing that during all that time there had been no

wiuusness, and that during part of it ehe had heen able to do

rd work.

PATUOLOGY OF MIND. [oh

I

■

I

to produce insanity, than any other tumour or gros^ morbid
product in the brain. Caries of the skull from syphilis may do
mischief by extension of morbid action, just as caries from
of the hones of the ear may do.

COSCLUDIXG REUAEKS.

-bid^

do

om

i

A pregnant but very difficult q^ueation, of which little or no
thought has ever been taken by writers on insanity, is — What ia
the canse of the particular form which the disorder takes in a
given case J Why does It assume one complexion rather than
another ? At the outset it is certain that what appears to be
the same cause shall occasion different forms of insanity in
different persons, and even in the same person at different
periods of life, and tliat the same form of disorder shall be pro-
duced by different causes ; this being so, it ia plain that the
special determining conditions lie hidden ia that unknown
region which we call by such names as tempcravicnt and idio-
syncrasy. Unfortunately these big words are at present little
better than cloaks of ignorance ; they are symbols representing
unknown quantities rather than words denoting definite con-
ditions ; and no more useful work could be undertaken in
psychology than a patient and systematic study of individuals —
the scientific and accurate dissection and classification of the
minds and characters of j^riicidar men in correlation with
their features and habits of body. How vast a service it
■would indeed bo to have set forth in formal exposition the
steps of the quick process by which the shrewd and experienced
man of the world intuitively judges the characters of those
whom he has to do with, and refers them in a moment instinct-
ively to their proper classes in his mind! Our systems of
psjchology are too abstract and ideal to be serviceable ; disdain-
ing to concern themselves with the individual, or shirking the
tedious work of observation for the easier work of speculation,
they give no help whatever in the education of the sane or in

e treatment of the insane mind.

Inasmuch as no two persons in the world are exactly alike in

cir mental character and development, no two cases of mental

TUE CAUSATION AND PKEVENTION OF IKSAXITY.

i

^^Berangeinent will be exactly alike ; the varieties of tbeu- morbid
^^Hj^tures may well be as many as tbe varieties of individual
1^™ eharacter. The brain stands not on the same footing aa other
organs of the body in regard to its development as the special
oi^n of mind ; while their respective development and function
are very much the same in all persons, requiring no training to
do their work, and their diseases accordingly are closely abke,
the real evolution of the brain as the organ of mental function
takes place after birth in relation with an individual's circum-
stances, and so gives rise to some variety of function in each
pei-son with corresponding variety of structure in the delicate
fabric of thought ; wherefore it ia that each of two cases of
deranged mind which resemble one another in the general
features of exaltation or of depression, and perhaps also in
the character of the delusions, will still display its particular
features. Notwithstanding these superficial varieties of details,
however, there is great sameness in the leading types of insanity,
which makes it in the end monotonous and oppressive ; the
patients fall into one or other of a few classes, and those, who
consort with them may justly complain of the lack of invention ;
the manifold dilferences are superficial and incidental, tlie same-
ness is fundamental and essential ; and it is certain that he who
has studied well the inmates of one lai^e asylum will know the
essential character and main features of the madness of all ages,
of all countries, and of all classes of men. Productive, in the
sense of creative, activity is the highest function of the best
endowed and most soundly developed mind.

Aa a general thing it may be presumed that the melancholic
temperament will predispose to a melancholy madness, the san-
giune temperament to a more expansive variety of derangement,
the suspicious temperament to a derangement in which delusions
of persecutions prevail. But this is not always so: a melan-
cholic person may rage, and a sanguine person may mope in
madness. The seat of tbe iirimary disease sometimes affects
the result ; injuiy to the head and gross disease of the brain
tend lo cause intellectual r.ither than emotional disordSr, while
^^ abdominal disease favoura the occurrence of emotional depres- ^^
^^^sion; the organic conditions of the intellect being, as Miillei'^^H

n

( S38 PATnOLOQY OF MIND, [.m

remarked, mainly in the brain itself, and " tlie elements which
maintain the emotions or strivings of self, in all parts of the
oi^anism." However, this is trnc only of disease of brain which
has made some progress, since the derangement caused by injuiy
and gross disease is often mainly emotional in its early stages;
the probable reason being that at this stage the initial disturb-
ance in the nerve-centres is very much tlie same as that which
is caused by irritation from a distant orgnn or by vitiated blood.
It has notj at any rate, gone beyond the stage of functional
derangement, which has emotional expression, into the farther
stage of disorganisation of structure which implies intellectual
derangement When disease of the heart goes along with mental
disorder, not seemingly as an accident, but in an essential con-
nection with it, as it sometimea does, the latter usually takes the
melancholic form with extreme apprehensions and fears^a sort
of panphobia ; it yields indeed a striking contrast to the more
or less active mania which goes along with tubercular disease
' of the lungs iu some instances. Notable in this relation is the
extremely sanguine disposition of the phthisical patient who,
not being in the least insane in mind, is buoyant with unfailing
hope in spite of fast-failing strength, and perhaps projects on
the very edge of hia grave what be will do many years after he
shall have been laid in it.

The bodily changes that accompany the changes of age have
something to do with the form which the disease takes. No one
fuels and tliinks concerning the things of this world at fifty
. years of age as he did at thirty; what wonder then that the
character of the mental derangement befalling at tliese ages
should differ? Breaking out in youth and active manhood, when
the circulation of the blood is vigorous and the eneigics of the
body are at their full height, mania will be more common than
melancholia, unless the health has been brought low by long
luffering of body or mind previous to the outbreak ; in old age,
when the circulation is languid and the vessels are undei^oing
degeneration, and when bodily energy is waning, some variety of
melancholia or some degree of decay of mind is more often met
with. Sex again will obviously impress its mark upon the

;tital disorder iu some instances, although it does not make so

T.] THE CAUSATION AND PREVENTION OF INSANITY. 239

much difference in the main types thereof as one not considering
the uniformity of passion in the sexes might expect. It is clear
as day that temporary bodily conditions, hovever they may have
been brought about, will play their part ; and it may well be that
future researches will discover the causes of the characteristic
features of some varieties of mental derangement in the diathetic
states and the actual bodily disorders which are associated with
them. Should this come to pass, we may hope to be put in
possession of more exact and complete medical histories than
we have now, upon which may be raised in due time a natural
classification of insanity that shall furnish definite information
concerning the cause, course, probable termination and most
suitable treatment of a particular case which belongs to one of
its classes.

The degree of development which the mind has reached cannot
fail to imprint some marks upon the phenomena of its derange-
ment ; these will be more'Various and complex in proportion as
it is more cultivated. A child soon after its birth could not
manifest true ideational disorder ; it must acquire ideas before
it can have them deranged. For the sanie reason the madness of
an Australian savage will be a simpler matter than that of a
normal European, which may be expected to exhibit evidence of
the wreck of culture and perhaps of its degree also. The belief
in witchcraft is common among savages, and it is not surprising
therefore that a melancholic savage oftentimes has the delusion
that he is bewitched. Had an insane person in this country
that delusion, we might feel sure that he was not very enlight-
ened ; if he had more knowledge he would probably ascribe his
sufferings to persecution by magnetism or by some mysterious
chemical agency. The delusions of the insane present broken
reflections of the principal beliefs of the age, and of the social
and political events of the time ; so much so that Esquirol
affirmed he could trace the history of the French Eevolution
from the taking of the Bastile down to the last appearance of
Buonaparte in the character of the insanity which occurred
during its successive phases. Any striking incident, or any
great personage who is much before the public gaze, is apt to be
laid hold of by the insane mind and to be made the occasion of

w

^K pur

PATnOLOGY OF MIND. [cB

i

a delusion. It is of Ultle moment then in most cases what the
particular delusion is ; the important thing is the affective mood
in which it ia rooted, and from which it drawa its life. The
vain and ambitious person may claim to be an inspired prophet
or even Jesus Christ, if his thouglits have been much given to
religious matters ; to be a king or a prime minister, if he ia a
politician ; to have solved tho problem of perpetual motion, if
lie has a smattering of physics : it matters not what he thinks
himself; no cure will be found for his delusiou of greatness so
long as he is swollen with the conceit of which the delusion h-j
the moi'bid outcome. ^

Whosoever surveys madness as a whole, considering within
himself that there must be at bottom something which all cases
have in common, and asks what is the quality of nature which
shows most in those who become its victims, shall have occasion
for some instructive reflections. One thing fails not to be
brought forcibly home to those who live among the insane—
namely, how completely they are wrapped up in self, and what
little hold the cares and calamities of those who have been
living intimately with them ever take of them. It would be
no exa^eration to say that a person might live for years with a
company of insane people who were far from being demented,
and, appearing no more among them because of sickness or of
death, hardly be asked for more than once out of a transitory
curiosity. Living together for years they, as a rule, show no
interest in, and no sympathy with, one another. It is not a
conscious selfishness on their part; their own morbid feelings
and morbid thoughts engross their attention so entirely that
nothing that affects others touches them deeply. Another
observation which those who have to do with insane persons
have frequent occasion to make is, that when they are recovered
they seldom evince any gratitude for what has been done for
them, however much attention and anxiety their sufferings may
have claimed and received ; with some rare exceptions they are
quick to forget services and hasten to ignore any sense of obli-
gation. No doubt this is owing partly to the social prejudice
-gainst insaiiiLy; it is natural that they should shun all

^Vt.] the causation and prevention of insanity.

reference to a calamity which their relatives, who perhaps share
their peculiarity of lemperament, are nervous unwilling they
should refer to, and which the world looks upon as something
like disgrace. But this is not the whole, nor always the main
reason : some of them cannot sincerely recognise that tliey have
been as ill as people have thought them, perhaps in their hearis

(ascribe their insane doings to the treatment which they under-
went, and while remembering acutely every particular of whiit
they suffered, forget entirely what they made others undergo.
Kor can we wonder at it when we reflect how strong is the ten-
dency of any sane person whose passions are stiiTed or whose
-interests are deeply engaged to see things from his own point of
view exclusively, and to transform his own perturbed feelings
into quahtiee of the object, and how complete his incapacity is
tu take an opponent's standpoint and to enter into his feelings.
It has been said that anger is a short madness ; it would be no
less true to say that madness is sometimes a long passion.

Having noted this extreme development of what may be
called selfhood or self-feeling among the insane — for it is not
that conscious self-love which is properly aelfishness^ — one may
fitly inquire whether it is not oftentimes the morbid develop-
ment of a natural disposition. It will be found, I think, that a
great many persona who have gone insane have had uitense
self-feeling without a counterhalaucmg intellectual grasp. The
friends of such a one wOl say of him perhaps tliat he was of a
very sensitive nature, that he could not bear criticism or opposi-
tion, that they found it necessary often to keep disagreeable
things from him, and the like ; and tliia tkey will say sometimes
not by way of apology for an infinuity, but as if ifc were a
virtue of a finer nature than common, and as If it were not
every person's business in the world to have and. to bear all
sorts of impressions. There is a class of persons who are unable
to bring themselves into sober and healWiy relations of sincerity
with the circumstances of life ; who let feeling loose and give
rein to imagination on all occasions ; who are wanting in quiet
reasonableness, and cannot apprehend the notion, much less do
the practice, of the subordination of self as an element in a com-
W^ plex whole; some of them turn all impressions to suspicion.

^V^S PATHOLOGY OF MIND. [cb«)

take offence easily, brood over slights, magnify trifles, fed'
acutely that opposition hurts their self-love, and, identifyiug their
selfhood with truth and right, persuade themselves that they
are snffering great wrong, They are sometimes very insincere,
though not always consciously ao ; assenting eagerly, effusively,
and for the time being sincerely, to some proposal or advice,

• immediately afterwards the habitual distrust of their self-
regarding tendency invites its sympathetic ideas, and they begin
to discover hidden motives of self-interest in the adviser's counsel,
and repent of their assent. Acute in their suspicions, they in-
variably overreach themselves and fall into the hands of plausible
charlatans who play upon their weaknesses. That is one reason
why ignorant but audacious impostors have a success in lunacy
practice which they cotild not have if real medical knowledge
and skill were required of them.

Others who are not entirely wrapped up in themselves are
almost wholly wrapped up in their faniihes ; it is a sort of
vicarious gratification of self One hears it said of some woman
who has fallen melancholic, and who thereupon displays all the
self-indtilgent habits so common in such cases, that she was a
moat amiable person, singularly devoted to her husband and
children, not in the least regardful of self, and that she is now
as unlike her tme self as can possibly be imagined. But hus-
band and children do not really constitute the world, and an
excessive devotion to them might in such case he the most
thorough gratification of self, and too exclusively absorbing to
mark a wholesome reasonableness of life. So again a person
who is generous in giving away money may have been extremely
self-regarding, self-fostering, perhaps little scrupulous in the
getting of it ; and if he becomes a moaning hypochondriac or
melancholic who can do nothing but think and talk of himself

I and his sufferings, it is not perhaps quite true to say that his
present self is not in the least like his former self.
It is a common but by no means indisputable opinion that
the philanthropist is the least eeliish of men ; it would be more
true to say that he is commonly a person of extraordinary self-
feeling who finds gratification thereof in his philanthropic
labours. Touched acutely in Lis feelings by the spectacle of

>ic

1

v.] THE CAUSATION AND PREVENTION OF INSANITY. 243

sufifering and of wrong, he reacts with an intensity of immediate
energy in the endeavour to make things better, and he obtains
a relief of his lacerated feelings as well in proclaiming to the
world how much he is afflicted and in depicting vividly the
wrongs which afflict him, as in active works of benevolence.
All the while he may be minutely and habitually exacting and
self-indulgent in his family relations. The philanthropy which
embraces mankind is indeed too apt to overlook the family ; and
there are not wanting examples to prove that the martyrs in the
cause of mankind can make martyrs of those who are in daily
intimate relations with them. The humble and irksome duties
and abnegations of daily life exact quiet and steady self-disci-
pline, yield no striking occasions for the ease of outraged senti-
ment, claim not public attention and sympathy, necessitate an
unostentatious subordination of self and its affections. They do
not suit well, therefore, with the sentiment-nursing character of
the pliilanthropist and with the vanity which the public pursuit
of his ends is apt to foster. The world does well, no doubt, to
applaud the philanthropist for the work which he does, in order
to the encouragement of men to set before themselves high aims
of human welfare, but on the whole it is well for the world that
it is not composed entirely of philanthropists.

The religious ascetic of former times, who fled from the society
of men to some hole in the rocks or to some desolate place of
the desert, and there inflicted upon himself all the sufferings
which his invention could devise, mortifying his body with long
fastings and many stripes, was persuaded that he did a very
holy thing, and was applauded by the world as a great saint.
The truth was that he had nursed an exaggerated selfhood into
something like madness. So far from having the merits which he
imagined himself to have, he would have found it a much harder
penance for him, as well as a more wholesome discipline, to have
done his modest work, like other people, as a humble member of
society. As it was, by bringing his body into a state of emacia-
tion, and by engaging his thereby enfeebled mind in continual
meditations on what Satan would do specially to tempt and to
torment him, or God would do miraculously to comfort and to
sustain him. he bred hallucinations which he believed to be actual

I apP

PATHOLOGY OF MIND. [oH

I

i

apparitions to him of the lloly or of the Evil One. If he did'
not truly see visions of that sort, ho had brought hiuisdf to so
unstable aud spasmodic a state of mind as to declare lie did
without heing sincerely conscious of his insincerity ; not otber-
■ffise than as hysterical women, mnrbidly eager to gain sympathy
and notoriety, will counterfeit all sorta of diseases, or, if their
minds have dwelt much on sexual matters, will accuse innocent
persons of criminal assaults upon them, without beiug themselves
sincerely conscious of their duplicity and fraud. Were we to
believe the accounts which some of these saints gave of their
encounters with the devil, we should be driven to conclude that
he had put aside all other business in order to use his utmost
and undivided energies to shake their steadfast righteousness.
Their fanatical follies were really the outcomes of insane self-
hood which had identified itself with religion, just as the sancti-
monious and self-righteons Pharisee identifies his pride with
religion, and thanks God that he is not as other men are. But
as an ape seems more deformed from its resemblance to man, so
tlia aping of humility by religious pride makes it more oJiona.

We perceive then that a character which persons who become
insane often have in common is an exaggerated and ill-tempered
self-feeling, by reason of which they are unable to see things in
their true relations and proportions to themselvea and to one
another. Great self-feeling with little self-knowledge and little
self-control is the soil most propitious to the growth of egoistic
passion : either to such passion as marks the striving of the indivi-
dual for increased gratification of self, as, for example, amhition,
avarice, love; or to such passion as marks the reaction of self
against that which opposes its gratification, as, for example,
envy, jealousy, wounded self-love, despondency. And the natural
outcome of such a passion grown to excess is delusion. But
there is countervailing advantage in great self-feeling — that it
imparts great earnestness and intensity to character : what is an
evil sometimes in supplying strength to narrow convictions aud
fire to intemperate zeal is a benefit to the individual in enabling
him to make a stand undaunted against opposition, though he
stand alone. The good side of this we see exemplified in the
reformer; the bad side of it in the lunatic. A conviction gaina

I.] I'HE CAUSATION AND PEEVENTION OF INS.VMITY.

E

^^HmGaitely in strength, as Novalis rcmarkei.), when another peraoa
^^V 'believes it, as another person will not fail to do if it be based
^^F upon sound experience and be a true evolution of thought.
But the lunatic's couviction needs not in the least the increase
of strength which sympathy of thought gives ; assent adds
nothing to its ibrco, nor does dissent take anything from it ; he
would not believe more firraiy in it if all the world believed
with Iiim, and he holds fast to it notwithstanding that all the
world scorns it. One might say then of great self-feeling that
it confers the power of becoming a reformer or the liability of
becoming a lunatic according aa the circumstances of life are
propitious or not, and according to the greater or less capacity
of intellectual insighb and of self-control by which it is
accompanied.

It was Aristotle who took notice that great men are inclined
to be melancholy and hypochondriac. In them the self-feeling
is great; they do not easily subordinate themselves to things as
they are, but would have them as they should be ; accordingly,

►when their energies are directed outwai'ds to the accomplishment
'Of some aim under the guidance of their superior insight, the
earnestness of gi-eat feeling inspires their convictions and is
infused into their actions; such happy use of their energies
freeing them from their melancholy. "W hen they are not actively
employed, having no more great things to do, they are prane to

kfall back into melancholy, although they have commonly, by
virtue of their great intellectual power, sufficient self-control to
prevent it from passing into actual insanity.

Weighing well the manner of its causation, as set forth in the
foregoing pages, it is obvious that mental derangement must
needs be a matter of degree. There may be every variety (a)
[.«f deficient original capacity, that is of deficient development
the substratum of the mental oi^anisation, whereby the indi-
vidual is born incapable of successful adjustment to his environ-
ment, ancestral antecedents being to blame; (b) of deficient
development of the mental organisation after birth, the cause
thereof lying in some injury or disease, or in faulty education —
that is, iu unfavourable conditions of the environment; and (e\

'4^

^_ ne

^Lth

I

PATHOLOGY OF MIND. ['

of degree of degeneration, attesting the divers rcaiilts of deranged
intei-action between the individual and his environment. Be-
tween the lowest depths of idiocy and madness and the highest
reach of mental soundness there are numerous varieties shading
so insensibly into one another that observation may pass along
the whole series by a gentle gradient, and it will be impossible
for any one to draw a definite line to mark where sanity ends
and insanity begins. It is no wonder then tliat the question of
civil and criminal responsibility in these cases should be a most
difficult one to answer ; on the one hand, there are insane
persona who are responsible for what they do, inasmuch as they
are plainly determinable by considerations of self-interest, and are
capable of much self-control and of keen foresight when they
have strong enough motives to exercise them ; on the other hand,
some sane persons are plainly not responsible for what they do
in certain circumstances, since no motive can take hold of them
at the time to move them to do otherwise than as they do.

There are two views of insanity prevalent which, in order to
clearness of thought, ought to be distinguished — namely, the
medical view of it as a disease ref|uiring treatment, and the
legal view of it as an affliction incapacitating an individual from
knowing his obligations and from performing his functions as a
citizen. Prom a. medical point of view a person may be so insane
as to justify his being p\it under care and treatment in order to
be cured — particularly as experience has proved beyond all
iquestiou that the sooner suitable treatment is used the better is
the chance of recovery, and the longer ifc is put off the less likely
is recovery ever to take place — who, at the same time, may not
be so dangerous to himself or to others as to render him unfit to
Ije at large and to have the care of his own property. The law
admits the medical view of the necessity of treatment by sanc-
tioning the placing of a person of unsound mind under restraint
fls " a proper person to be placed under care and treatment " ; but
it goes beyond this special view of his welfare to a wider con-
sideration of his responsibilities as a member of society : it does
not accept unsoundness of mind by itself as a discbarge from
responsibility for criminal acta or as sufficient evidence of in-

['^j^^

^H capacity to do civil acts, hut exacts proof of such a degree id^^|

^

^bl(

Rj THE CAUSATION AND PKEVEN'TION OF INSANITY.

kind of insanity in a pitrticuliir case as it liolda to be suflicient
to abrogate responsibility. In the eye of the law then a man
may be mad, and yet not mad enough to be irresponsible as a
citizen — medically, not legally mad; he may be a proper subject
for medical treatment because of derangement of mind, and at
the same time a fit subject for judicial condemnation if he
breaks the law. So far the legal doctrine is theoretically jnst,
although its practical application is beset with difficulties.

But the English law is not satisfied to rest there ; it goes on
to set up authoritatively an artificial criterion of responsibility
in criminal cases, aud insists on trying every case by it, notwith-
standing that the test it sets np is nnphilosophical in theory,
and discredited on all hands by practical experience of insanity ;
in fact, contrary to all true legal principles, it goes out of its
■way gratuitously to lay down as sound law an exploded psycho-
logical dogma, which is not law at all, but false doctrine — to wit,
that the insane person is responsible for his criminal act if at
the time of doing it he knew he was doing wrong, or knew that
the act was contrary to law. We may bring home to our minds
in the clearest way the meaning and the working of this test,"
when strictly applied, by considering what would be the pro-
bable woiking of an enactment that every person suffering from
eouvulsions of any sort, whose consciousness was not entirely
suspended while they lasted, should be held strictly responsible
for not stopping them. As no one who knows anything of
mental philosophy believes impulses to action to come from the
'intellect, and to be always under its sway, and as no one who
has bad much to do practically with insanity has the least doubt
that a person labouring under it is constraiued sometimes by his
disease to do what he knows to be wrong, having perhaps gone
tlunngh unspeakable agony in his efforts to withstand the
morbid inipulse before he yielded to it at the last, all suitable
occasions should be taken, in order that right and justice may in
tlie end prevail, to declare how unjust is the legal ma.tim, and
to protest against its application.

Another but less serious fault in the law concerning lunacy is

the want of proper provision for the discriminative treatment of

lose who have been pronounced by it to be persons of unsound

^^V rail

^^M cor

I

I

848 PATilOLOGT OF MIND. [cB

raiud ; for tho judgment is made iu all cases to carry with it tlia
conclasion, not always well founded, tliat they are both inca-
pable of taking care of themselves and of managing their affairs.
Nevertheless, an insane person is sometimes competent to manage
his affairs who 13 not fit to be entirely at large ; and, on the
other hand, there are some who, not being competent to manage
their affairs, might very well be permitted to be at large after
fitting legal provision had been made for the proper management,
of their property. We are getting too much into the habit of
looking upon insanity as a special and definite thing, which
either is or ia not, and wjiieh, if it is, puts the sufferer at once
out of the category of ordinary men; unmindfud that we are
dealing not with a constant entity, but with a multitude of
insane individtials who manifest all degrees and varieties of un-
Boundness. A conseiiuence of this habit ia an undue readiness
to pronounce insane, and to conRne in asylums, persons who
exhibit deviations from the usual tracks of thought and conduct,
which in former times would have been considered harmless, or
in some instances actually received as inspirations. Tlius the
'world is now robbed of the good which it might get from eccen-
tric ideas and novel impulses ; for assuredly in the past it has
been greatly indebt^id to those who have braken away from the
automatic grooves of thought and conduct, even when their
originaUty has perhaps been only the beginning of insanity.

With these observations I conclude what I have to say con-
cerning the causation of insanity. They will have shown
perhaps the necessity of taking wider views of the origin and
nature of the disease than has been done hitherto. They may
admonish us too not to let these abortive minds pass without
taking to heart the lessons -which they are fitted to teach.
Examples of failure of adaptation to the conditions of life, they
trace in suffering the downward path of degeneracy, and indicate
at the same time the opposite path of evolution ; thus they teach
that, not wasting strength in vain regrets over calamities that
are past remedy, men should apply themselves diligently to
get understanding of the laws of nature, and to bring their

^K lives into faithful harmony witli thcni. N^^l

v.] THE CAUSATION AND PIIEVENTION OF INSANITY. 249

APPENDIX.

In order to illustrate more fully this chapter on the causation
of insanity, 1 appended in former editions the short notes of fifty
cases, all of which were under my care at one time, and in which I
laboured to satisfy myself of the conspiring causes of the mental
disease. I might adduce a great many more cases, but do not, as
those which follow cover pretty well the field of causation, and,
being quoted without any selection, are sufficient for purposes of
illustration.

1. A captain in the army, and the only surviving son of his
mother, who was a widow. She suffered very much from scrofulous
disease, and he was wasting away with suspected phthisis. Mental
state, that of demented melancholia, with manifold delusions of
suspicion as to pernicious vapours and other injurious agencies that
were employed against him. He was the last of his family, two
brothers having died very much as he seemed likely to die. His
grandfather began life as a common porter, ultimately became
partner in a great manufacturing business, and, having amassed
enormous wealth, made a great display in London on the strength
of it. His high hopes of founding a family on the wealth which it
was the sole aim of his life to acquire thus issued.

2. There was direct hereditary predispo5?ition, and the tempera-
ment was notably excitable through life. There was no evidence
of excesses of any kind, but there had been great business anxieties.
The mental disease was genei*al paralysis.

3. An amiable gentleman, on the death of his wife, formed an
immoral connexion with a woman of loose character. Continual
sexual excesses, with free indulgence in wine and other stimulants,
ended in general paralysis.

4. A conceited Cockney, the son of a successful London tailor
and money-lender, mean in look as. in mind, strongly imbued with
the tradesman's spirit, and with offensive Dissenting zeal. Hope-
lessly addicted to self- abuse, and suffeiing from the disagreeable
form of mental derangement which follows that vice sometimes.

6. Two ladies of middle age, unmarried, and cousins. They both
suffered from extreme moral insanity, both revealing in their con-
duct the tyranny of a bad organisation. There was much inswaifc^

250 PATHOLOGY OF MIND. [chap.

in the family, in one case the father being actually insane ; and in
both cases the parents being whimsical, capricious, and very in-
judicious as parents. A bad organisation made worse by bad
training.

6. An unmarried lady, aged 40, addicted to the wildest and
coarsest excesses, though of good social position and of independent
means ; justifying in every respect her conduct, though it more than
once brought her to gaol. Family history not known, but insane
predisposition suspected strongly, as there was plainly not the least
moi*al element in her mental organisation. No aim nor occupation
in life, but extreme egoistic development in all regards.

7. A publican, cet. 31, had done little for some time but stupefy
himself with brandy in his own bar-parlour. The consequence was
furious mania and extreme incoherence : acute mania from con-
tinued intoxication, not delirium tremens. — Recovery.

8. A woman, set. 47, of dark complexion, sallow skin, and bilious
temperament, who was said to have suffered much from her hus-
band's unkindness and domestic anxieties, underwent " the change
of life,*' and became extremely melancholic. Nothing more was
known about her. — Recovery.

9. Hereditary predisposition marked. First attack, set. 38, when
unmarried. Second attack, set. 58, she having a few years before
married an old gentleman in need of a nurse. She was given to
taking stimulants, fancied herself ill, and was always having tbo
doctor to talk over her ailments and to recommend her some stimu-
lant ; in fact, hypochondriacal melancholia grew gradually by indul-
gv nee into positive insanity. — Recovery.

10. A married lady, set. 31, without children, and having great
self feeling. She went on one occasion to a Methodist meeting,
wh?re she was much excited by a violent sermon ; immediately
afterwards went mad, fancying her soul to be lost, and making
attempts at suicide. — Recovery.

11. A young lady, set. 25, who had undergone some anxieties at
home, suffered a disappointment of her affections. Blank depression
and vacuity, having all the look of acute dementia. — Recovery.

12. A married woman, set. 44, of dark and bilious temperament,
had never had any children. At the " change of life " profound
melancholia came on.

13. A gentleman, aged 60, of fine sensitive temperament, whose
mother was said to have been very flighty and peculiar, had himself

v.] THE CAUSATION AND PEEVENTION OF INSANITY. 251

been noted for peculiarities through life. He became profoundly
melancholic, thinking himself ruined, and was intensely suicidal.
Refusal of food. Everything taken, however, was vomited, and
diagnosis of organic abdominal disease, probably malignant, was
made. — ^Death from exhaustion.

14. A bookseller, set. 41, temperate, of considerable intellectual
capacity, but of inordinate conceit ; advocated a general division of
property and other extreme theories. Ultimately he got the notion
that there was a conspiracy against him on the part of the Govern-
ment, and tried to strangle his wife as a party to it. After an
illness of two years he died of phthisis, with many of the symptoms
of general paralysis. The bodily disease seemed to have conspired
with a great natural egoism, and thus to have made the mental
derangement one of its earliest symptoms.

15. A married man, set. 50, of anxious temperament. Profound
melancholia ; refusal of food. Second attack. Apart from the pre-
disposition established by a former attack, the cause seemed to be
great self -feeling, assuming a religious garb, or at any rate getting
its discharge in religious emotion. Very fervent always in devo-
tion, but intense egoistic feeling ; entire reference of everything to
self, and natui-al incapacity to take an objective view. — Recovery.

16. A single lady, set. 38, fancied herself under mesmeric in-
fluence, in a state of clairvoyance, and had a variety of anomalous
sensations about her body. Rubbed her skin till it was sore in
places, bit her nails to the quick, scratched her face, <fec. Quasi-
hysterical maniacal exacerbations, in which she could not contain
herself, but tossed on a couch or even rolled on the floor in violent
unrest. Irregularity of menstruation, and suspected self -abuse. —
Recovery.

17. A lady, ait. 45, but looking very much older, having had an
anxious life. Hereditary predisposition; change of life; melan-
cholic depression, passing into destructive dementia. Convulsions,
paralysis, death. Here softening of the brain was preceded for
some weeks by mental symptoms.

18. Hereditary predisposition. Great excesses. General paralysis.

19. Habitual alcoholic excesses; pecuniary difficulties; mania.
After some years hemiplegia of right side, muscular power being
partially regained after a time. The patient lived for years thus.
Paralysis of long duration was the usual family disease and cause
of death.

PATHOLOGY OF WIKD. [cn*i

^

^^H^ 20. Suicidal insanit}' in a mitn'ied lady. SLi'ong li^i'cdttary pre-
^^B disposition to insimity. Exbanstioa produced by Inctatlon, and
^^H mental depression occasioned by tbn long absences of her husband
^^H from home. — Recovery.

^^^ 21. Third or fourth attack of acute moaning melandiolin in a.
^^H woman, aged 40. Intense self-conceit and eelli:«tiness natiu'al to
^^^ her. Giistrio derangement, and obatinatcly constipated bowels.
^^1 Whenever bodily derangement reaches a certain pitch, or adversity
^^1 occurs, it seoms to upset the equilibrium ot an ill-balanced mind,
^^g pi-edisposeil to disorder by an exaggeiated egoism and by former

attacks . — Keco ve ry .

22, Gambling, betting, drinking, and sexual excess.

paralysis.

123, A had organii^ation plainly — not due to actual insanity
family, but to the absence of moral element. A life of great ex-
citement, and of much speculation in Australia. Alcoholic and
sexual excesses (1). General paralysis.
24, A widow, o;t. 53, the daugher of one who had begun life as &
labourer at a coal wharf, but who had risen to be an employer, and
had made a great deal of money. Ho was without education, so
that bis daughter, brought up as a rich person, but without cultiva-
tion of body or mind, did not get opportunely married ; " She was
too high for the stirrup, and not high enough for the saddle."
"When 50 years old, she married an old gentleman, whose former
manner of life had made a nurse needful to bim. He died, and left
her the income of a large property for her life. She now got
Buspicioua of his relatives, to whom the property was to revert on
her death ; was harassed with her money, which she did not know
what to do with, but fancied others had designs on ; and finally
went from bad to worse until, believing all the woild was con-

IBpii'ing against her, she got a revolver, and threatened to ghoot her
fancied enemies.
25, The daughter of a common labourer, who had become veiy
rich in the colliery business, ret. 32, single. At her father's death
she inheHted wealth ; was without any real education, very vulgar,
and spent the greater part of her time in drinking gin and readi
sensational novels. Great hereditary predisposition, not to i:
only, but to suicidal insanity. Suicidal melancholia, with
coherence approaching dementia.
26, A gentlemnn, ret. 3i. Steady, quiet drinking, on all possible

ty

v.] THE CAUSATION AND PREVENTION OF INSANITY. 253

occasions. The "ne*er-do-weel** of the family, having tumbled
about the world in Mexican wars and South American mines, and
in other places, as such persons do. General feebleness of mind and
specially marked loss of memory. An uncle had been very much
the same sort of person, and had died in an asylum. In speaking
of himself — if describing what he had been doing, for example —
always spoke of himself as " you," as though he were addressing
himself as some one else.

27. A married woman, aged 49, gaunt, and seemingly of bilious
temperament. After a fever of five weeks* duration, called " gastric,"
probably typhoid, acute maniacal excitement, violence, incoherence,
tkc. — Recovery within a fortnight.

28. Dementia after epilepsy, the fits occurring at the catamenial
period. Brother maniacal, and sister without the moral element in
her disposition.

29. The young lady before mentioned as No. 11 was removed by
a penuiious father from medical care before recovery was thoroughly
established, and in opposition to advice. The return to home
anxieties brought on an attack of acute mania, with endless gabbling
of incoherent rhymes. — Permanent recovery this time.

30. A warehouseman, aged 35, a Primitive Methodist, much
addicted to preaching. He had accomplished some self-education,
but had a boundless conceit, and infinite self- feeling. Indigestion,
pyrosis, frequent vomiting after meals. Melancholia, with delusion
that he had committed the unpardonable sin and endless moaning.
Very remarkable was the evidence of self -feeling in his case — self-
renunciation not being a word that entered into his vocabulary.
This man, for example, though well aware that vomiting followed
eating, and sufficiently afflicted thereby, could not be induced to
regulate his diet voluntarily, but ate gluttonously unless prevented.

31. A married woman, set. 32, of stout habit of body, and with
habitually locked secretions. The sudden death of a son brought
on severe moaning melancholia.

32. A single lady, aged 57, who had been insane for thirty years.
There was the strongest hereditary taint.

33. A young man, extremely delicate, aged 22, had acute de-
mentia, following acute rheumatism. There was valvular disease
of the heart, with loud miti*al regurgitant murmur. — Issue of the
case unknown.

34. A tradesman's daughter, set. 24, brought up in idleness,

264 PATHOLOGY OP MIND. [chap.

and in habits unsuited to her station. Slight hereditary predis-
position, much aggravated by her injudicious education. Domestic
troubles and anxieties after marriage, she being unequal to the
management of a household. Mania. — Kecovery.

35. A woman, set. 30, Wesleyan, single. Suicidal melancholia
with the delusion that her soul is lost. Menstrual irregularity.
Extreme devotional excitement, with evidently active sexual feelings.
— Recovery.

36. A young woman, set. 25, single, Wesleyan. Mania. Cause,
same probably as in the last case. — Recovery.

37. A respectable, temperate, and industrious tradesman, set. 40,
Wesleyan, a teetotaller, and much superior to a vulgar wife. Second
attack. His father committed suicide ; his brother was very flighty.
General paralysis.

38. A sober, hardworking, respectable bookseller, not given to
excesses of any kind, so far as was ascertained. But here, as in
many other cases, one lacked knowledge with respect to possible
marital excesses. Slight hereditary predisposition. General paralysis.

In both these last cases there was general paralysis in men who
had not been intemperate. In both, however, there were large
families of children, and the struggle of life had plainly been very
anxious and severe.

39. A woman, set. 32. Acute mania came on two months after
childbirth.

40. A lady, set. 34, single, without other occupation or interest
than religious exercises. Suicidal melancholia, with the delusion
that she had sold herself to the devil. Amenorrhoea. — Recovery.

41. A married woman, set. 40. Sudden outbreak of mania, after
going to a revival meeting. Amenorrhoea. — Recovery.

42. A married man with a family, set. 52, a Dissenter, holding
an office of authority in his church, and most exact in his religious
duties. Secretly, he had of late kept a mistress, however, and
lived a rather dissipated life. Outbreak of acute mania, with
a threatening of general paralysis. — Recovery ; for a time at any
rate.

43. Acute mental annihilation in a young man about a year and
a half after marriage. One or two intervals of a few hours of
mental restoration. — Death in epileptiform convulsions. Softening
of the brain in extreme degree, but lim'ted in extent. Excessive
sexual indulgence.

v.] THE CAUSATION AND PREVENTION OF INSANITY. 255

44. A married woman, set. 44, who has had several children, and
who has hecome insane after each confinement. Extreme maniacal
incoherence and excitement, with unconsciousness that she has had
a child. — Recovery.

45. Hereditary predisposition. A Dissenter of extreme views,
narrow-minded and bigoted. He was married when thirty-six
years old, and became melancholic a short time after the birth of
his first child. — ^Recovery.

46. Complete loss of memory and of all energy of character, and
failure of intelligence, in a man, set. 36, single, from continual
intemperance in drinking and smoking. Has previously had two
attacks of delirium tremens.

47. An extremely good-looking young widow, who had been a
s'nger at some public singing-rooms and the mistress of the pro-
prietor of them. Sexual excesses. General paralysis.

48. Attack of acute violent mania in a young surgeon, set. 27.
Afterwards three days of heavy stertorous sleep ; then seeming
reoovery for twenty-four hoiu-s ; but on the next day recurrence
of mania, followed soon by severe epileptic fits. — Recovery.

49. Extreme moral perversion, with the most extravagant conceit
of self and unruly conduct in a young man, a clerk. Alternations
of deep depression and suicidal tendency. Cause, self -abuse.

50. A single lady, aged 41, who, on her return from school when
fifteen years old, was queer, listless, and from that time had been
rather peculiar. Hereditary predisposition. Acute melancholia,
with the delusion that she is lost because she has refused an ofPer
of marriage from a clergyman, such offer never having been thought
of by him.

12

CHAPTER VI.

THE INSANITY OF EAKLY UFE.

How unnatural ! is an exclamation of pained surprise which
some of the more striking instances of insanity in young
children are apt to provoke. However, to call a thing unnatural
is not to take it out of the domain of natural- law, notwithstand-
ing that when it has been so designated it is sometimes thought
that no more need be said. Anomalies, when rightly studied,
yield rare instruction ; they witness and attract attention to the
operation of hidden laws or of known laws under new and
unknown conditions ; and so set the inquirer on new and fruit-
ful paths of research. For this reason it will not be amiss to
occupy a separate chapter with a consideration of the abnormal
phenomena of mental derangement in children.

The first movements of the child are reflex ; but sensorial
perceptions with motor reactions thereto follow tl>ese early
movements so soon that we can make only an ideal boundary
between reflex and sensori- motor acts. The aimless thrusting
out of a limb brings it in contact with some external object,
whereupon it is probable that a sensation is excited. The particu-
lar muscular exertion must also be the condition of a muscular
feeling of the act ; so that the muscular sense of the movement
and the sensation of the external object are associated, and for
the future unavoidably suggest one another : a motor intuition
of external nature is thus organised, and one of the first steps
in the process of mental formation accomplished. The same
educational process goes on in the exercise of the movements of

t

.'I.] TUE INSANITY OF EARLT LIFE, 257^

the lips and tongue, which are the parts first exercised hy a
child, and in the motion of its hand, which it puts to ita mouth
in order to suck it. AfterwaKls, whatever is grasped in the
hand is similarly carried to the mouth. Tlius the sensibility
and motion of the lips are the first inlets of knowledge; the
child having got thereby some perception of an external object
as the occasion or accompaniment of a certain association of sen-
sations and movements, immediately brings any object which
it grasps with its fingers into relation with these means df
instruction. In this way the hand La used to exercise the sen-
sibility and motions of the lips, and the knowledge previously
gained through them is applied to instruct the hand, which at
a later period, when it has been taught by its own experience, is
applied to other parts of the body, in order to help to interpret
and localise their sensations. But it is long before the infant can
localise a sensation in another part of its body than ita lips and
hand; when a pin in its dress is pricking it, for example, it can
only cry out helplessly ; it cannot make a definite effort with
the hand to remove it, as it will do later on, when it has learnt
to know the geography of its own body. If we call to mind
how, when discussing actuation, it was shown, in the case of the
eye, that a sensation was the direct cause of a certain accommo-
dating movement, aud that the definite movement thereupon
imparted the intuition of distance, we shall perceive liow the
oi'ganic association of a sensation from without with an associ-
ated muscular act builds up by degrees definite intuitions of
external objects in the young mind.

Suppose now that an infant becomes insane soon after birth,
what sort of insanity must it exhibit ! The range and variety
of mental disorder possible are clearly limited by the extent of
existence of mental faculty; which is almost nothing. Id this
regard the observed facts agree with theory ; for when a child
is, by reason of a had descent or of baneful influences during
uterine life, bom with such an extreme degree of instability of
nerve element that, on the first play of external ciicumstancea
its nervous centres react in convulsive fashion, it mostly dies
convulsions. The disordered action proceeds from the ner-

lus centres of reflex action — those which alone e.t XX^'ft 'CNSfis.

^B he

^M thi

TATHOLOGY OF MIND.

^

I

have power of function ; the convulsiona are the equivalent in
them of the delirium which is the exponent of derangement
of the ideational centres, — might be said to represent their
nsanity, as insanity, on the other hand, represents, so to apeak,
convulaive action of the higher nervous centres.

In consequence of the close connection of sensorial action
with reflex action in the infant — the actual continuity of
development which exists — there is commonly evidence of
some Bensori-motor disturbance in the earliest nerve-trouhlea.
An impression on the sense of sight, for example, is not quietly
assimilated so as to persist as an organised residuum in the
proper nervous centre, but immediately stimulates the un-
stable cells of the associate motor centres to irregular and
violent actions, which may be of a more or less purposive
character ; and the consequence is that the phenomena of a
true sensorial insanity are intermixed with the morbid manifes-
tations of the lower nervous centres. Instances of such morbid
action so soon after birth are certainly rare ; nevertheless they
are met with now and then, and have been recorded. Crichton
quotes from Greding a well-known case of a child which, as
lie says, was raving mad as aoon as it was horn. " A woman,
about forty years old, of a full and plethoric habit of body,
who constantly laughed and did the strangest things, but who,
independently of these circumstances, enjoyed the very best
health, was, on the 20th January, 1763, brought to bed, without
any assistance, of a male child who was raving mad. Wlien he
■was brought to our workhouse, which was on the 24th, he pos-
sessed 80 much strength in hie legs and arms that four women
could at times with difficulty restrain him. Tliese paroxysms
either ended in an uncontrollable iit of laughter, for which no
evident reason could be observed, or else he tore in anger every-
thing near him, — clothes, linen, bed-furniture, and even thread,
wheu he could get hold of it. We durst not allow him to be
alone, otherwise he would get on the benches and tables, and
even attempt to climb up the walls. Afterwards, however,
when he began to have teeth, he died."

If there he not exaggeration in this description it must be
itllowed to be very surprising that a child so young should have

*.] THE INSANITY OF EAiiLY LIFE. SSM

been able to do so niucli ; and those who advocate innate mental
faculties might well ask how it is possible on any other sup-
position to account for so extraordinary an exhibition of more
or less co-ordinate power by so young a creatura Two con-
siderations may be suggested by way of lessening the extra-
ordinary character of the phenomena : first, that the mother of
the child was herself peculiar, bo that her infant inherited an
unstable nervous organisation, and consequently a disposition to
irregular and premature reaction on the occasion of an external
stimulus ; and secondly, that there are innate in the constitution
of the human nervous system the aptitudes to certain co-ordinate
automatic acts, such as correspond in man to the instinctive acts
of animals. Many young animals are born with the power of using
their muscles together in complex ways for definite ends directly
they are exposed to suitable stimuli, and the human infant is
not destitute of the germ of a like power over voluntary
muscles, while it has the complete power of certain co-ordinate
automatic acts ; one can conceive, therefore, that, without will,
and even without consciousness^ it may display, when insane, in
answer to sensations, actions which have more or less semblance
of design inthem^ — in other words, convulsions that are more or
less co-ordinate. If people would keep open minds and not begin
to observe with a pre-existent idea that the function of the
highest nerve-centres means something essentially different from
the functions of lower nerve-centres, they would not have the
difBculty they have in recognising co-ordinate convulsion. We
have in fact convulsive display of innate co-ordinate faculty in

• irregular, violent, and destructive movements, and in precocious
ftots which would be natural in a more restrained form at a later
'«tage of normal development, such, for example, as "uncon-
trollable fits of laughter without any evident reason." * Without

' " That thej do diia by instinct, something implanted in the frame, tJie
mechftiiiBni of tlie hody, before any marks of wit or reason, are to be seen
^^^ in tliem, I am fully persuaded ; as I am hkewise that nature teaches them
^^^HAb manner of fighting peculiar to tlioir species ; and children strike witli
^^Hneir arma as naturally as horses kick, dogs bite, and bulls push witti their
^^HfemB."— M&{JDBViu.&'s Faille af the Bee*, vol. ii. p. 352.

^^Bthi

Tde youngest person whom I have seen labouring under mania," BayB
A. Morison, "was a little girl of six years old, under my care in
ihloliom Hospital. I liavo, however, frequently met viitti vwAss*. wa^.

I

I

I

r«60 PATUOLOGY OF MIKD.

doubt the paroxysms of violeut laughter were provoked by the
morbid coudition of tlio motor centres, not by any mental
conceit of the infant.

As the earliest stages of the infant's mental development cor-
respond in a general way with the permanent condition of miud
of those animals whose actions are reflex and sensori-motor, it
ia no wonder that their morhid phenomena are comparable.
Being in both cases mainly referable to disorder of tlie senaoria,!
and associate motor nervous centres, the insanity might not
unfitly be described as sensorial. The impressions made npon
animals, and the sensations or at most the few simple and im-
perfect ideas that follow them, are transformed immediately
into movements, as they are also in children ; nothing like
true reflection is possible, except ifc be in a few of the higher
animals ; consequently when the impressions are morbid they
are answered instantly by morbid movements. The elephantj
usually a gentle enough creature, ia subject at certain seasons to
attacks of furious madness, in which it rushes about in the
most dangerous way, roaring loudly and destroying everything
within its reach ; and other animals are now and then affected
w4th similar paroxysms of what might be compared with an
epileptic fuiy. There is far more power in the insane elephant
than in the insane infant, and it is able to do a great deal more
mischief, but there is no difference in the fundamental nature
of the madness j the furious acts are the reactions of morbid

QTimauagpable idiots of a very tender age." Dr. Josopli Franlt records
laving seen, on a visit to St. Luke's Hospital, in 1802, a case of mania
oflcuiTiiig at tbe age of two yeara. — Leciura on Itmmitu, by Sir A. Mori-
sou, M.D. In tlie Appendix to one of tlie Heporta of tlie Scotch Ltinacy
CommissionerB, mention is made of a girl aged eix years, wlio was said to
be afflicted with congenital mania. Slie was illegitimate, and her mother
waa a prostitute. She could not walk, paraplegia having come on when
ebe was a year old : she was incoherent, and subject to paroiysmH of
violent passion ; at all times very intractable ; slept iittle and ate liirgely.
All such cases may be vien-ed as partial idiots from birth. The cerebral
organisation at so early an age is eo delicate that it does not bear severe
morbid affections without losing its fitness for mental development and
endangering life. Indeed it might fairly be said of the cases of insanity
in very young children, that some are examples of intellectual deficiency,
the rest examples of moral perversion or deficiency, with or without excite-
ment. Epilepsy goes along with the inaiiiu suiiieliiiies, and tlie lenUeucy
■~ to bam, tear, injure, destroy, &c.

2<^^

I

i

nj THE INSANITY OF EARLY LIFE.

motor centres to impressions made on morbid sensory centres ;
and the whole mind, whether of the infant or of the animal, is
engulfed in the convnlsive reaction. Dogs being as a rule
very intelligent animals, because of their intimate association
with men through countless ages, exliibit something more than
sensorial disorder whea they go mad, although a great part of
the phenomena are sensorial. Their disposition and habits
notably suffer a great change ; they become sullen, dull, irri-
table, solitary in their habits; afterwards hallucinations evidently
occur, and they bite alilie friends who are kind to them and
strangers who take no notice of them or who threaten them.
M. Magnan has produced experimentally very vivid haUucina-
tiona in dogs by injecting alcohol into their veins : the animal
starts up, stares wildly at the bare wall, barks furiously, and
seems to rush into a combat with an imaginary dog ; after a while
it ceases to fight, retires, growling once or twice in the direction
of its discomfited adversary, and settles down quietly.

So soon as we have recognised the existence of insanity which
is mainly sensorial, we become sensible of the value of the dis-
tinction. Not only does it furnish an adequate interpretation of
the violent phenomena of the insanity of the animal and of the
infant, but it alone suffices to explain that desperate fury which
sometimes follows a succession of epileptic attacks in the human
subject. When the furious epileptic maniac strikes and injures
whatsoever and whomsoever he meets, and, like some destructive
tempest, storms through a ward with convulsed energy, he has
no notion, no consciousness, of what he is doing; to all intents
and purposes he is an organic machine set in the most destruc-
tive motion ; all bis energy is absorbed in tlie convulsive explo-
sion. And yet he does not rage quite aimlessly, but makes more
or less determinate attacks upon persons and things : he sees
what is before him and destroys it; there ia that method in his
madness; his convulsive fury is more or less co-ordinate. Tlia
desperate deeds are respondent to morbid sensations in which his
consciousness is entirely engulfed; often there exist terrible
hallucinations, such as blood-red flames before the eyes, loud
roaring noises or imperative voices in the ears, sulphurous smells

the nostrils ; any real object which does present itself before

i

I

PATHOLOGY OF MIND, [ch

the eyes is seen witli the slrangest and most unrpal characters ;
lifeless ohjects seem to threatea his life, and the pitying face of
a friend hecomes the menacing face of a devil. His frantic
deeds therefore do not answer to the realities around him, but
to the unreal surroundings which liia sensorial anarchy has
creiited : ^ they are the motor exponents of Jjis fearful halhicina-
tiona. Tor the time heing there is a true sensorial insanity, the
functions of higher nervous centres being in abeyance; and
after the frantic paroxysm is over there is complete forgetful-
i ness of what has happened during it, as there is foi^tfulness of
sensori-motor action in health. Differences between this epi-
3 fury and infantile insanity arise, out of the residua, sensory
and motor, which, wanting in the child, have been acquired and
oi^anised through experience in the nei^ve centres of the adult ;
the sensory residua render possible in the adult special halluci-

> nations which the infant cannot have ; while the residua in the
motor centres which are the basis of the secondary automatic
faculties render possible, in like manner, a degree and variety
of violence which the infant, possessing only such germs of
co-ordinate function as are original, must needs fall short of.

The transformation of disordered sensation into disordered
movement is not so quick and violent in all cases. As the
child adds day hy day to the number of its definite perceptions,
and accumulates the materials of reSection, the distracting and
inhibitory operations of which come into play, there is a less
strong tendency to instant motor expression of sensory states,
Halluciuations may therefore come and go, or persist for a

I time, without provoking any violent movements. I might
indeed justly distinguish two classes of cases: one class in
which a violent and convulsive reaction, the result of the in-
stant transformation of impressions into movement, masks all
other features of the disease, and gives it an epileptiform charac-
ter ; another class in which tlie active sensory residua persist in

1 An epileptic, under my cure, nsunlly amild and gentle being, used to
become a moat violent and danKeroiis maniac after a aeries of litB, and to
commit terrible destruction. He thought at tiiese times that he
fighting for his life against a lion, nnd hia despfrate nctiona wen
e:iponents of hia niciitul ohaos.

I

THE INSANITY OF EARLY LIFE.

^

conscitjusnc33 as haliucinations, giving rise, if tboy g
answering movementa, to such as are more ekorcic in character,

A variety of insauity in cliildren, then, ■which we may next
consider, is that form of sensorial insanity in whith hallucina-
tions occur, and in which the motor reactions are not convulsive
and epileptiform, hut apaamodic rather and choreic. There is
reason to think that temporary or fugitive halluci nations arc
not uncommon in infancy, and that the child when stretching
■ out its hand and appearing to grasp at an imaginary object is

f deceived sometimes by a subjective sensation which has been
excited by an internal bodily state, just as a smile or a frown
on its face is excited oftentimes by a purely bodily state. Ex-
perimental proof of this manner of origin is not wanting : Dr.
Tbore mentions the case of an infant, aged fourteen months and
a half, wliich had accidentally been poisoned by the seeds of
the Datura stravionium, a drug which, like belladonna, is well
known to disorder the sensory centres ; hallucinations of sight
occurred, as shown by the motions of the child, which seemed

»to he constantly seeking for some imaginary objects in front of
■it, stretching out its hands and clinging to the sides of the
cradle in order to reach them better,' The most remarkable
.«xaraple of such condition of hallucination is afforded, how-
jpver, by that form of nightmare which some children suffer so
much from : possessed with a vivid hallucination, they begin
to shriek out in the greatest terror without being awake, though
their eyes are wide open ; they tremble or are almost convulsed
with fright, and do not recognise their pai'ents or others who

» attempt to calm them ; and it is some time before the paroxysm
subsides and they can be pacified. In the morning they know
nothing of the fright which they had, but have forgotten it, as
the somnambulist forgets his midnight walk, or as sensation is
commonly forgotten. Strictly speaking, however, it is not right
to say that they forget the experience, because the activity was
all the while sensorial; and as there was no conscious perception,
aa the child did not perceive that it perceived, there could be
no conscious memory. The undoubted and not uncommon occur-

■reuce of these vivid hallucinations in children, when the mattet^^—
> Annalea Midko-Pf!idioh'ji\u.e^ 1849. ^^H

^^B lias

^V sho

^f pos

PATHOLOGY OF MIXD. [i

loai^l

liaa certainly passed beyond ordinary dreaming, will serve to
show how probable it is that they have sometimes, -when awake,
positive halliioinatioDS. And if a very young child is affected
with hallucinations, it cannot help believing in them any more
than the dreamer can ; it cannot correct sense by reflection,
since the higher nervous cenlres of thought have not yet entered
upon their function, Thoy may therefore exist temporarily
in children without indicating any serious disturbance of ths
health; the organic residua of a sensation being stimulated to
activity by some trilling and transient bodily derangement.

It is in conformity, then, with pathological observation as
well as with physiological principles, to affirm the existence in
children of a variety of sensorial insanity which is characterised
by hallucinations, most frequently of vision, and sometimes by
answering irregiUar movements. Fits of Involuntary laughter
are often witnessed in such cases : the iaugh, or rather smile, of
the infant is an involuntary sensori-motor moveuient, before it
has any notion of the meaning of the smile or any consciousness
that it is smiling; consequently we meet with an irregular and
convulsive manifestation of this function as the motor expres-
sion of a morbid state of things. Dr. ^Vhytt relates the instance
of a boy, aged 10, who, in consequence of a fall, had violent
paroxysmal headaches for many days. After a time there
occurred " fits of involuntary laughter, between which he com-
plained of a strange smell and of pins prickiiig his nose ; he
talked incoherently, stared in an odd manner," and immediately
afterwards fell into convulsions. He recovered on this occasion,
but two years afterwards was similarly attacked: he had severe
headache, saw objects double, and suffered from a severe pain in
the left side of his belly, confined to a spot not larger than a
shilling; "sometimes it shifted, and then he was seized with
fatiguing fits of involuntary laughter." Ultimately he recovered
partially, but never completely.^ One ought to take particular
pains in all ca.?es of hallucination in children to make a close
examination of the state of the general sensibility of the body ;
for perversions or defects of it will frequently be found both
whera there are corresponding perversions of movements and
' Oi>. cil. p. 144.

n.] THE INSANITY OF EARLY LIFE. 265

wlicre there are not. Because, however, this form of sensorial
insanity is often associated with movements of a more or less
choreic character, and because, as compared with the previously
illustrated epileptiform variety, it has relations not nnlike those
which chorea has to epilepsy, I have described it as the choreic:
variety of sensoiHal insanity.

With each succeeding pi-esentation of an object to a child
the impressions made on the different senses by it are more
exactly felt and more perfectly combined, so that an adequate
idea of the object is at last organised in the higher ideutiouiil
centres ; there is a consilience of the sensory impressions into
the idea, which thenceforth makes it possible for the ohild to
think of the object when it is not present to the senses, or to
have a definite and adequate perception of it when it is. As
development proceeds, one idea after another is thus added to
the mind until many simple ideas have been oi^anised in it ;
for a long time, however, these ideas remain more or less isolated
and imperfeclly developed ; there are not definite and complete
associations between them expressing their relations, and the
cluld'a discourse is consequently incoherent ; there is not more-
over a complete organisation of residua at first, and its memory
is consequently fallacious. Children, like brutes, live in the
present, their happiness or misery being dependent upon im-
pressions made upon the senses: the idea or emotion excited
does not remain in consciousness and call up other ideas and
emotions, so modifying the sense of present pleasure or pain
by memories of what has been felt before, which may tend to
inhibit action, but it is directly uttered in outward action.
Such a condition of development, which is natural to the child
l)efore the fabric of its mental organisation has been built up,
and to the animal, in which tlie constitution of the nervous
system renders a higher mental development impossible, would,
were it met with in an European adult, represent idiocy, or an
arrest of mental development from morbid causes.

So soon as definite ideas have been organised in the child's
mind delusions are possible. But as ideas are at first compara-

Itively few in number, and as their organic associations are very ^_
hnperfect, a derangement of the function of their ceutTi^^ \&.'«ti|^^|

I

P»6 TATUULOGY OF MIND. [cnju

needs be characterised by very incoherent delirium. Divers
raorbid idena will spring up without coherence ; and the morbid
phenomena, wanting syateia, will correspond, not so much with
those which in the adult we describe as mania, where there is
B more or less systematized derangement, some method in
the madness, as with those which are known as dtUrium,
when ideas spontaneously arise in consciousness in the most
incoherent way. Let me proceed then to test these principles
by an examination of such facta as are available.

As a morbid idea in the child's mind has, by the nature of
the case, but a small range of action upon other ideas, it tends
to utter itself by its other paths of expression ; namely, by a
downward action upon the sensory ganglia or upon the move-
ments. When it acis downwards upon the sensory ganglia it
gives rise to a hallucination ; and in such cases, as may easily be
imagined, it will not always be possible to determine whether
the hallucination is really secondary or primary — whether, tliat
is to say, it is engendered indirectly by tlie action of the morbid
idea upon the sensory ganglion, or directly by the excitation of
the sensory residua by some OT^anic irritation. If a child which
is only a few years old sees strange figures of some sort on the
wall, which have no real existence, but disappear with apparently
as little reason as they came there, the hallucinations are most
likely owing to some organic cause of disturbance which affects
directly the sensory ganglia. But if a child of eight or nine
■years old, whose head has been filled with foolish and dangerous
notions concerninf; the devil, or who has, when naughty, been
threatened by its nurse with tlie terrors of a black man who
will come and carry it off, suddenly sees a devil or a black man
appear and shrieks in terrified agony, then the hallucination is
secondary to the recklessly implanted delusion. Doubtless this
sort of idea-produced hallucination occurs frequently enough
in those nightmares of children which have been already
mentioned.

The secondary generation of hallucinations again is strikingly
illustrated by the occuiTcnce of phantasms before the eyes of
certain precocious children of nervous temperament who create
For themseh-es scenes and dramas 'which appear to be visible

P.0
I'epresentat

1

■TL] TOE INSANITY OF EAHLY LIFE. 2G7

jous of the thouf;iits that are passiug through their
niiuda: what they think, that they actually see, just aa the
dreamer does. Accordingly a sort of drama is represented
before their eyes in which they take their part, and they live for
the time in a scene which is purely visionary as though it were
quite real. " Wljat nonsense you are talking, child ! " the
mother perhaps exclaims ; and thereupon the pageant vanishes.
Or they talk of imaginary scenes of the kind as if they had
actually occurred, and are accused of, or even punished for, false-
hood in consequence : not always wisely, seeing that on account
of the vividness of the hallucinations and the absence of a
store of registered ideas ia their minds they are more apt to
believe them real events, and less qualified to correct them, than
older persons are. In delicate and highly nervous children,
predisposed to or affected with meningeal tubercle, it sometimes
happens that great anxiety is caused to the mother by tlie
strange way in which, during the night, when outer objects are
shut out by the darkness, they will talk as if they were sur-
rounded by real events, or, aa the mother perhaps puts it, as if
they were light-headed. They are dreaming while they are
awake ; though the outer world is shut out, the morbid deposit
within acta as an irritating stimulus to the ganglionic nervous
centres, and thus gives rise to an automatic activity of them.
In one case, which came under my notice, of & scrofulous child
with large, irregularly formed head, terrific visions of the kind
occurred in the night when it was wide awake. It would
shriek out in fright, exclaiming that there was something in the
bed. The moonlight was especially obnoxious to it, because, it

lid, " it makes so much noise." There was a well-marked
pwn on the forehead when it looked towards the window or
the light — a leas degree of the photophobia which occurs in
tubercular meningitis. These children of a tubercular tempera-
ment are sometimes extremely precocious in mind ; so much so
that old women shake their heads gravely, and justly remark
that they are too forward to live. Tliey show excessive
nervous apprehension in one way or another, and at the same
.time perhaps an extraordinary absence of natural fear in another

ilation ; one delicate little creature used to shriek wLfch. ttvj^

PATHOLOGY OF MIND. [on

if another child or a doa came towarda it in tlie street, and yet
delighted in a stormy wind, no matter how high ; and another
child would go up instantly, without the least fear, to any strange
dog that it met and seize bold of it, never coming to havm.

Hallucinations may undoubtedly be fugitive events in the
history of any child endowed with a highly nervous tempera-
ment, as in William Blake, the engraver, and may not denote
any positive disease ; but if the habit grows upon the child hy
indulgence, and the phantasms are regularly marshalled into a
definite drama, — as, for example, was the ease with Hartley
Coleridge, — then a coudition of things is initiated which will in
all likelihood issue ultimately in some form of mental disorder.'
For it is not the natural course of mental development that
I ideas, so soon as they are fashioned in the mind, should operate
' directly downwards upon the sensory ganglia, and thus create a
visionaiy world ; on the contrary, it is necessary to the progress
of mental development that ideas sliould be completely organ-
ised within the centres of consciousness, and act upon one
another tiiere ; that thus, by the integration of the like in
[ perceptions and the diHersntiatiou of the unlike, accurate con-
' ceptions of nature should be formed and duly associated in the
mental fabric; and that the reaction upon external nature
should be a definite, aim-working, volitional one. Men like
Hartley Coleridge cannot have a will, because the enei^ of
their supreme nervous centres is prematurely expended in the
construction of toy-works of the fancy; the state of things
corresponding in some sort with that which obtains in the
spinal centres when, by reason of an instabiUty of nerve ele-
ment, direct reactions take place to impressions, so that definite
assimilation and acquired co-ordination are rendered impossible.
In both cases an arrest of right development, commonly
Ltbe forerunner of more active disease, is indicated; in both
' cases there is the incapacity for a true education. The pre-

' "Blake's first vision was saiil to be when 1ie was eight or ten years
old; it woB a vision of a, tree tilled with angels. Mrs. filoke, however,
used to Bay — ' You know, dear, the first time you saw God waa when jou
four years old, and He put Hia head to the window und nel you
ming."'—Gihh[ieVB Life of Blake.

^^kforea/i

^^Bt] THE INSANITi' OF EARLY LIFE. Sfi^^H

cocious imagination, or rather fancy, of childhood should be
checlced aa a danger rather than fostered as a wonderful evidence
of talent ; the child being solicited aud trained to regular inter-

* course with the realities of nature, so that by continued internal
adaptation to external impressions there may be laid up in the
mind good stores of material, aud that, by an orderly training,
this may be moulded into true foi-ms, according to which a
rightly informed imagination may hereafter work in true and
sober harmony with nature.

The ditference between fancy and imagination, as Coleridge
aptly remarked, corresponds with the difference between delirium
and mania. The fancy brings together whimsically images
which have no natural connection, but which it yokes together
by means of some accidental coincidence, so making creations
that are oftentimes essentially inconsistent or untrue ; while the
imagination combines images like or unlike, by their essential
relations, and so gives unity to variety. Now the precocious
imagination of a child, which is sometimes the delight of foolish
parents, cannot possibly be anything more than lying fancy ;
and this for exactly the same reason that the insanity of
children must be a delirium aud cannot be a mania — the in-
complete formation of adequate ideas and tlio absence ol
definitely organised associations between them. Those, there-
fore, who consider closely and without prepossession the funda-
mental meaning of the character which the delirium of children
has, will not fail to perceive in it the strongest evidence of the
gradual organisation of mind; the fancy of the sane and the
delirium of the insane child both testifying to the same condi-
tion-of things— that which the habitual incoherence of a child's
discourse also evidences.

In order to set forth clearly the manner of action of morbid
idea in children, and to educe therefrom a physiological lesson,
its operation has been artificially separated from other morbid
phenomena which usually accompany it. In young children it
is practially rare to meet with disorder limited to the supreme
nervous centres ; the other centres are almost certain to be more

■or less affected. In chorea, for example, besides the disordered , _
Jiovements which are its cominon characteiistic, there may b^^^H

I

PATHOLOGY OF MIND.

ballucinatious mnikiog disorder of the seiisorial centres, and
motiveles3 weeping or laughing, or acts of mischief and violence,
marking disorder of some of the higher motor centrea ; there are
furthermore in some caaea mental excitement and incoherence.
which may pass into maniacal delirium and end fatally, or into
chronic delirium and end in recovery. The diEFereut nerve
centres sympathise with one another; and, according as they
minister to ideation, sensation, or movement, express their
disorder in delirium, hallucination, or spasmodic movements.

Having treated of the phenomena of mental derangement in
yonng children generally from a pathological point of view, I
now go on to arrange in suitable groups the different forms that
are met with in practice.

Corresponding with the principal varieties of motor dis-
order that occur in children as in adults, three nearly allied
groups of mental disorders might be described and called respec-
tively choreic insanity, cataleploid insanity, and epileptic insanity.
They are not of courae distinctly separate groups, since inter-
mediate cases between one group and another prevent a plain
line of division being made, but the greater number of cases in
each group have common characters which render it convenient
to bring them together.

Choreic Insanity. — There is a choreic mania sometimes met
with in children which appears to be the exact counterpart of
the choreic spasms that occur. "What is sufficiently striliing,
even to an ordinary observer of this mania, is its marked in-
coherence and its manifestly automatic character. It seems as if
the connections of the primary nerve centrea had been dislocated,
and as if each centre were acting on its own account, givingrise
thereby to a sort of mechanically repeated and extremely inco-
herent delirium. A boy of about eleven years of age, who came
under my care, was, after a slight and not distinctly described
sickness, suddenly attacked with this form of delirium ; he
moved about restlessly, throwing his arms about and repeating
over and over again such expressions as — " The good Lord
Jesus," *■ They put Him on the cross," " They nailed His hands,"
&c. It was impossible to fix his attention for a moment ; for
he tnrncA away when the attempt was made, wandered aimlessly

TUE INSANITY OF EAELY LIFE. 271'

about, pointiug to one liand and then to the other, and bahbling
his incoherent utterances. So far as could be made out, there
considerable insensibility of the skin over certain parts of tha
body, as there commonly is in this form of insanity. In two
days, after appropriate treatment, the delirium passed off, and
the boy was quite himself aga,iii, I once saw an interesting
case of insanity in a girl, mt, foarteen, who was lively, pretty,
and intelligent. From time to time she would suddenly jump
up in the evening in a paroxysm of excitement, exclaiming,
" Mother, I'm dying ! " and begin praying frantically in a
mechanical manner. The paroxysm lasted for three or foni"
hours, and left her pale, cold, exhausted, and trembling like a
leaf. A brother had died after being similarly afflicted. When
I saw her she looked somewhat strange and was foi^etful ; she
used to imagine sometimes too that she saw the bed on fire and
dead bodies on the ground, knowing all the while that the
visions were haUueinations. The mother suffered for months at
one time from speecldess melancholia, and nearly all her family
had died from phthisis. She had had fourteen miscarriages,
and three children who died at early ages, this girl being the
only one left ; wheu pregnant with her she had a terrible fright
from seeing one child accidentally killed, and the girl was horn
affected with constant choreic movements, which continued
until six months after birth. Before the paroxysms of mental
excitement came on, she had been subject to periodical attacks
of depression, in which she would cry for hours ; and all her life
she had suffered more or less from pain in tho bend, especially
in the left temple, with paroxysmal exacerbations thereof

A boy, aged twelve, was admitted into the Devon Asylum,
who had been afflicted all his life to some extent with chorea
A few days before admist-ion he had attempted to hang himi
and there was the mark made by tho rope upon his neck. On
admission he was acutely maniacal, attempted to dash his head
against the walls, and, when put in the padded room, lay on the
floor, crying — "Oh, do kill me! Dash my brains out! Oh, do
let me die!" He kicked and bit the attendants, and tried in
jvery way to kill himself: his head was hot, ]ih pulse quick,

I

n

j^^very way to kill himself: his head was hot, ]\U pulse quick, ^^H

[cbaSB

1*72 PATHOLOGY OF MIN'D. [c

he refused food, and did not sleep. He completely recovered
under proper treatment after a. few diiya.'

The most etriking example of mental derangement in a child

■ which Morel ever saw was in a little girl, let. eleven, who, after
the sudden disappearance of a disease of the akin, suffered from
choreic movements, and soon afterwards was attacked with a
maniacal fury. She attempted to kill lier mother, and nearly
drowned one of her sisters by throwing her into a pond of
water. In her paroxysms she displayed n strength almost
incredible, and it is scarcely possible to communicate, says
Morel, an adequate idea of the destructive tendencies of thia
httle being. She recovered after a fever when all medical treat-
ment had failed.

These cases will suffice as illustrations of choreic insanity. It;
is only necessary to bear in mind that, as with choreic move-
ments every degree of convulsive violence is met with in
different cases, so with choreic mania every degree of excite-
ment and incoherence is met with. Hallucinations of the
• special senses and perversions of general sensibility frequently
accompany the delirium.
Calaleptmd Insanity. — Another form which insanity takes
sometimes in childhood is that of a more or less complete
ecstasy ; and tliis may he fitly described as the cataleptoid
vaiiety. It generally occurs in young children. The little patient
lies perhaps for hours or days seemingly in a sort of mystical
abstraction, with limbs more or less rigid, or fi.ved in strange
postures; sometimes there is insensibility to impressions, whila

I in other instances vague answers are given, or there is utterly
incoherent raving, with sudden outbursts of wild shrieks from
time to time. These attacks are of variable duration, and are
repeated at varying intervals. They would seem to represent
B sort of spasm of certain nervous centres engrossing the whole
nervous energy, so that for the time being the body becomes an
automatic instrument of their exclusive activity, all voluntary
power being in abeyance. WTiile, on the one hand, there are
intermediate conditions between this form of disease and chorea,
its attacks, on the other hand, sometimes alternate with tnwvi
' I/'jHiial o/ Psi/chohgi<xi,l AU'lkiMj by Dra. Hack Tnke and Qucknffl^l

VLj THE INSANITY OF EARLY LIFE. 273

epileptic seizures, and at other times pass gradually into them :
it represents a class of hybrid seizures that stand midway
between chorea and epilepsy. In a girl who came under Dr.
West's treatment at the age of ten years and ten months, there
had been first an attack of general convulsions without any
obvious cause, when she was eight years old. Afterwards she
was subject to occasional attacks of great excitement of behaviour,
and for six months there was a sort of cataleptic state in which
she stood immovable for one or two minutes, staring wildly or
fixedly, and murmuring unconnected words that had reference
to any object which she might happen to see. About eleven
months from the commencement of these attacks their charac-
ter changed ; they became truly epileptic, the child's conduct
in the intervals between the seizures, though sometimes quite
reasonable, having mostly something insane about it.^ The
example shows the close relations of disorders of the different
nervous centres in children, their hybrid nature at times, and
the artificial character of the divisions usually made between
them.

Epileptic Insanity. — Not only ^re the different forms of
epilepsy met with in children, but also the different forms of
insanity that occur in connection with epilepsy. The petit mal
sometimes lasts for many months in children, and then passes
into regular attacks of convulsive epilepsy ; its usual effect
being to produce loss of memory and more or less imbecility of
mind. But whether epilepsy in children has the less patent
form of vertigo or the declared form of regular convulsions,
there is always great danger that it will occasion an arrest of
that cerebral development which is the basis of a good mental
organisation. In the case of a young girl, aged eight years,
of good physical conformation, who came under my care,
epilepsy seemed to have produced an arrest of mental develop-
ment at the sensorial stage : she was a most mischievous little
machine, never quiet, running about aimlessly and seizing, or
attempting to seize, whatever she saw; nowise content with
«

1 ** Ueber Epilepsie Blodsinn und Irrsein der Kinder,*' von Charles "West,
M.D. — Journal Jur Kinder krankheiten, vol. xxiii. 1854. See also a paper
by M, Delasiauve in Annales MMco-Psychologique, vol; vii. 1855.

TATHOLOGY OF HIND. [oH«

what slie caught hold of, but throwing it down directly she had
got it, and struggling for something else which drew her notice ;
not in the least amenable to correction or instruction, and de-
manding the whole energies of one person to look after her.
She WM an automatic machine incited by sensory impressions
to misciiievous and destructive acts.

As in adults, so in chihlren, an attack of violent mania, a
I fUTor transitoriiis, may precede, or take the place of, or follow
' an attack of epilepsy, being in reality a sort of mental epilepsy.
When the mania takes the place of the epileptic attack, oc-
curring in its stead, it is described sometimes as a masked
epilepsy — epUepsie larvie. Children of three or four years old
are sometimes seized with sudden attacks of violent shrieking,
desperate stubbornness, or furious rage, when they bite, tear,
and destroy whatever they can ; these seizures come on periodi-
cally, and may either pass in the course of a few months into
1 regular epilepsy, or may be found to alternate with epileptic
I attacks. They are a sort of vicarious epilepsy. Morel has met
■ with two cases in which children fell into convulsions and lost
I the use of speech in consequence of a great fear ; afterwards a
' maniacal fury, with tearing, destroying, and continual turbu-
lence, occurred : in one case, the child being ten years and a
half old, epilepsy followed ; in the other child, aged five years,
it did not.' One of the boys in a school was attacked in the
night, without evident cause, with a sudden furor transitoHus :
he rushed wildly up and down the dormitory, speaking loudly
but inarticulately, so that another of the pupils got up to quiet
him ; hut he seized the latter with great violence, and, but for
the inti'ifcrence of others, -would have strangled him. With
some difficulty he was got to bed; a true epileptic attack
followed ; and in the miiriiing he knew nothing whatever of
what had happened, but felt weary and exhausted.* Dr. Ludwig
Meyer, who relates this ease, relates another case of a boy, at.

113, who was subject to periodical attacks of fury, followed by
• TVaiM de* Maludita Mtintolts, 1R60, p. 102. He relateB also the hefore-
meiiliunod oiwe uf the girl, ost, 11, wholiad furious maniacal atUcks, during
wMoli (the alWiiipleii ta kill tier inottiar ancl injure her BisterB.
" " UuborMfitiiaTrajisitoriu," voii Dr. Lud«ig Meyor. Vircliow'a Ai

I

vol I

rvNM

f.} THE INSANITY OF EARLY LIFK. 27«'

1

i
i

epileptic convulsions, and who often had the furious maniacal
excitement without the convulsions, illustrating the trunsition
of mania transitoi-ia into epilepsy.

Some writers hold that when the mauia seems to occur in the
stead of epilepsy the truth ia tliat it has been preceded by
unobserved attack of epileptic vertigo. No doubt such an attack
oftentimes passes without being noticed, but it is only a surmise/
that it is so in all cases ; and as the maniacal outhrcJtk which
frequently precedes a fit may undoubtedly occur sometimea
rithout a following fit, why must it be sujiposed never to
scur without a preceding fit ?

.Again, in children, as in adults, regular attacks of maniacal:]
excitement may follow epilepsy. Many such instances are on
record ; but I shall content myself here with a singular example
of insanity, more cataloptoid perhaps than epileptic, following
convulsions, which is quoted by Griesinger from Kerner: —
Margaret B., jet. 11, of a passionate disposition, but a pious
Christian child, was, without any previous illueas, seiifed on
January 19th with convulsive attacks, which continued, with
few and short interruptions, for two days. So long as the con-
vulsions lasted the child was unconscious, twisted her eyes,
made grimaces and strange movements with her arms : from
the 21st January a deep bass voice proceeding from her kept
repeating the words, " They are praying for thee." When the
girl came to herself, she was wearied and exhausted, but knew
nothing of what had happened, only said that she had dreamed.
On the evening of the 22nd January another voice, quite
difi'erent from the bass one, spoke incessantly while the erisia
lasted— for half an hour, an hour, or several hours ; and was
only now and then interrupted by the former bass voice rogu-
hirly repeating the recitative. The second voice manifestly
represented a diiferent personality from that of the girl, dis-
tinguishing itself in the most exact manner, and speaking of
her in the third person. In its utterances there was not the
slightest confusion nor incoherence observable, but all questions
were answered by it coherently. What, however, gave a dis-
tinctive character to its expressions was the mora! or ratlipr
immoral tone of them — the pride, arrogance, acorn, find hatred.^

I

rATIlOLOQY OF MIND. [cUj

of truth, God, Clirist, that were avowed. "I am Use Son of
God, the Saviour of the world : me ye shall worship," the former
voice frequently repeated. Scorn of all that is sacred, blasphemy
against God and Christ, violent dislike of everything good, and
extreme rage at the sight of any one praying, or even of hands
folded as in prayer, expressed by the second voice — all these,
says the reporter, might well betray the work of a strange spirit
possessing her, even if the pious voice had not declared it to be
the voice of a devil. So soon as this demon spoke, the fashion
of her countenance changed in the most striking manner.
and assumed a truly demoniacal look. She ultimately qiiit«
recovered, a voice crying out — " Get thee out of thia girl, thou

■ unclean spirit" The case shows how naturally would arise the
once general but now abandoned notion that mania was due to
possession by an evil spirit or deviL
Although the delirium of childhood is commonly connected
with some form of convulsive disease, yet it sometimes occnrs
without convulsion, from other recognised causes of mania ; in

■ children these usually are blows on the head, intestinal worms,
and aelf-abuse. Worms in the intestines, like other eccentric
irritations, certainly act sometimes upon the supreme centres to
derange them, just as they act upon the motor centres to eKcite
convulsions. Children of a certain nervous temperament, who
have plainly inherited a tainted neurosis, now and then evince
^^ a singularly active and precociously vicious sexual tendency
^^L at very early ages, which is usually followed by or associated
^^M with great moral perversity and passionate outbreaks of temper
^" that are almost maniacal in some instances. Whatever their
nature, they are of bad omen for the child's future. Under the
name of Manopatkie f/meHEe Guislain describes maniacal attacks

Iin a young girl ret. 7, which were due to caries of the nose
following a blow. Other like cases are recorded by Haslam,
Spurzheim, Frank, Burrows, Perfect, and Friedreich,^ Certain,
acute diseases, as for example typhus, may give rise to delirium
in the child just as in the adult during their course, and to

"On tlie Psycliical DiaeaReH of Early Life,"
eitcs, 1859, by Dr. Ciiuhtuii Browiio.

I

¥

THE INSANITY OF EARLY LIFE. 277 ^H

disorder of mind during convalescence. In all these cases of
majiia in ctildren, however caused, we sliall not fail to notice a
mixture of imbecility, due to their state of imperfect mental
development, and of great moral perversion. And we may take
note, if we will, that an outbreak of passiou in some imbeciles
is, in its mental aspect, almost a temporary mania, and, iu its i

physical aspect, a convulsive paroxysm. ^^H

Ajfcctive Derangement. — Thus far I have given illustrations o^^^H
conditions of mental excitement with incoherence of ideas; I ^^|
now go on to notice conditions of mental depression in children,
with or without con'esponding morbid impulses and delusions
— cases in which the affective derangement is the predominant
symptom. The affective tane ia fundamental, due to the sympa-
tiietic system of the organic life, and is the medium which gives
colour to tlie ideas; and while the more lately acquired words
are the language of ideas, its more primitive language is cries, ^h
exclamations, modihcations of the toues of the voice and of ^^|
the bodily features. It is by these that feeling expresses itself ^^|
directly before the cluld has acquired ideas ; and when the chUd ^^
has acquired ideas and is able to utter them iu words, it still
expresses itself in the primitive way, but also indirectly through
ideas and their words. Witliout doubt children diifer naturally
in hveliness of disposition ; but it sometimes happens that
depression reaches such a pass even in very young children as
to constitute a genuine melancholia. In such case the child
whines and wails on all occasions ; whatever impression is made
upon it seems to be followed by a painful feeling ; the mother
takes it for medical advice, for, as she complains, it thrives not,
it rests not either by night or day, it is pining and crying con-
tinually, and nothing calms it ; there is no living with it, and
she is almost worn out with anxiety. Such symptoms mark
a constitutional defect of nerve element, whereby an emotional
or sensational reaction of a painful kind follows all impressions ;
the nervous or psyehial tone is radically infected with some vice
of constitution, so that every natural impression, instead of
being pleasing, is painful. The cause of the defect in some
instances is inherited syphilis ; at any rate beneficial results ^^J
^^^bUow the treatment for hereditnry syphilis. No doubt, haw- ^^|

[w^f

I

j:S78 PATHOLOGY OF MIND.

other causes besides syphilis may cause a like morbid
condition of nerve element. ,

With the deep melancholic depression there may be, in older
children, a distinct delusion of some kind. A boy who from
his fifth year had been rather peculiar in his behaviour, standing
still at times in the street 'witlicmt apparent reason and not
moving again without considerable pressure, was, when twelve
years of age, afflicted with positive melancholia and delusions of
suspicion. He was extremely depressed, and his manner in-
dicated the greatest fear: he was prone to weep constantly, and
was in great dread of his fellow -scholars and of his teacher, all
of whom, he thought, suspected him of anything wrong that
happened to be done — if a theft were committed, he was sure
that he was suspected to be tJie thief He was restless at night,
and often sighed and uttered unconnected words in hia sleep.
In five weeks he waa said to have recovered, but there still
lemaiiied eccentricities of conduct; if he kicked a stone, he
must return to kick it twice more; if he spat once, he must
Spit twice more ; if he had written a word incorrectly, he must
repeat the correction. Of these peculiarities he was quite eon-
Bcious, and struggled against them, but without avail; after
great restlessness and mental disquietude lie waa ultimately
obliged to give way to them.^ In other like cases, morbid
notions with regard to religion may be the exponents of the
emotional disturbance of psychical tone.

There ate boys who, being somewhat stupid and of a melan-
choly, moody, and perhaps morose disposition, habitually keep
apart from their fellows, whom they join not in play. They
are often hypochondriacal, complaining of strange morbid sen-
sations in abdomen, generative organs, heart or head ; and when
these morbid feelings are very active they become paroxysm-
ally excited so as to quite lose self-control, and perhaps imagine
that the devil has got hold of them. Or some other foolish or
insane idea or impulse springs up in the apt soil of their affective
perveraion and instigates them to foolish or insane conduct.
When they reach puberty they show more insanity, and perhaps
get into trouble; in a stupid way they attempt to kill thei

^^ get mto trouble; in a stupid way they attempt to kill theafe^—
^ » Irrmn bei Kii<iler, von Dr. Bpcklmra. vH

VI.] THE INSANITY OF EARLY LIFE. 279

selves or some one else, or do some other act of criminal
violence.

Perhaps the most striking form in which the melancholia
of children manifests itself is by suicide. So strange and
unnatural does it seem that a child of eight or nine years of
age should, world-weary, put an end to its own life, that one
is apt to declare the thing to be against nature and to consider
it inexplicable. Such act of suicide is done sometimes under
a sudden impulse from the dread of punishment or after the
infliction of punishment, or it is perhaps deliberately resolved
upon in a state of sadness and depression consequent upon
continued ill treatment by a brutal schoolmaster or parent.^
Falret mentions the case of a boy of eleven years of age, who
was driven by the ill treatment of his teacher into such a state
of melancholia that he determined to starve himself, and made
repeated attempts at suicide by drowning. But it may be
carried into effect out of a constitutional indifference or disgust
of life, or from a momentary impulse of disappointment when
there has been no real ill treatment, nothing more perhaps than
a slight rebuke or censure : one boy, aged nine years, killed
himself because he lost a bird which he was very fond of;
another boy, aged twelve, hanged himself because he was no
higher than twelfth in his class ; and a boy, aged twelve, hanged
himself because he was shut up in a room with a piece of dry
bread, as a punishment for having accidentally broken his
father s watch.^ This premature disgust of life is most often
the result of some ancestral taint, by reason of which the child's
nervous constitution is inherently defective, unapt to accom-
modate itself to its surroundings, and disposed to perverted
likings and dislikes and irregular reaction. The impulse which
springs up out of the deranged feeling, and is fed by it, is some-
times homicidal : an instance occurs from time to time in which
a child drowns, hangs, or otherwise kills another child, with an
amazing coolness and insensibility, and from no other motive
than a liking to do it ; and there have been a few cases recorded
in which more than one murder has been done in this way by

1 '' Etude 8ur le Suicide chez les Enf ants," par Durand F&Tdel—Annaks
Medico-Fsychologique, 1855. 2 Durand ¥^\^^\^ o-tq. cit,

13

280 PATHOLOGY OF MIND. [chap.

the same child. The question of hereditary taint is in reality
the important question in those cases^ as it is in all cases of
insanity of early life.

In the majority of instances the affective insanity of early
life might justly be described as hereditary ; but there are
some cases in which the morbid condition of nerve element
which manifests itself in extreme moral perversion is not in-
herited, but acquired by reason of vicious habits of self-abuse.
It is not correct, therefore, to describe all cases of so-called
moral insatiity in children as examples of hereditary insanity,
although the precocious sexual feeling which leads to self-abuse
is commonly the result of an inherited taint. I prefer using
the word affective to the word moral, as being a more general
term and expressing more truly the fundamental condition of
nerve-element, which shows itself in affections of the mode of
feeling generally, not of the special mode of moral feeling only ;
in other words, as pointing to that deepest affection of conscious-
ness in its primordial elements which makes it true to say that
his affective life betrays the real nature of the individuaL

The examples of affective insanity in early life fall naturally
into two divisions : (a) the first includes all those instances in
which there is a strange perversion of some fundamental instinct,
or a more strange appearance of some quite morbid impulse ; (b)
the second division comprises all those cases of complete moral
perversion which often seem to the onlooker to be wilful wicked-
ness. The former might be described as the instinctive or
impulsive variety of affective insanity; the latter as moral
insanity proper.

{a) Instinctive Insanity. — What are the inborn instincts of
mankind ? The instinct of self-conservation, which is truly the
law of the existence of living matter as such, and the instinct
of propagation, which provides for the continuous existence of
life, and is, therefore, in some sort a secondary manifestation of
the self-conservative instinct. The instinct to activity which the
organs of relation, that is, the organs of the so-called animal
life, evince, and to the particular sorts of activity which, being
adapted thereto by their form and structure, they accomplish,
znajr he Jooked upon as means which the two fundamental

THE liNSANlTY OF EARLY LIFE,

instincts make use of in order to attain tlieir cmls. Now tlie
instinct of self-con get vation is displayed not OLly by the in-
dividual creature, whether of low or high degree, bnt is implicit
in the life of every organic element of which it is built : it is,
as already seen, at the root of the passions, which are funda-
mentally determined hy impressions according as they are
pleasing or painful to self. Children are of necessity extremely
selfish ; for it is the instinct of their being to appropriate from
without, to the end that they may grow and develop : a baby is
the only king, as has been said, because everybody must accom-
modate himself to it, while it accommodates itself to nobody.
The necessary correlate of the instinct of appropriation where-
by what is pleasing to self is assimilated, is a destructive or
repulsive instinct or impulse whereby what is not grateful is
rejected, got rid of, or destroyed. The infant rejects the mother's
breast when from some cause, internal or external, the milk is
distasteful to it ; by crying and struggling it strives to get rid of
a bodily impression which may happen to be paining it, as the
Gregarina shoots away tiom a stimulus, as the snail retracts ils
protruded horns when they are suddenly touched, as a person
of tender sensibility shrinks from a painful spectacle; and
when it is a little older, it rejects, destroys, or attempts to destroy
what is not pleasing to it.

To talk about the purity and innocence of a child's mind is
a part of that poetical idealism and willing hypocrisy by which
men ignore realities and delight to walk in vaiu shows ; in so far
as purity exists It testifies to the absence of mind ; the impulses
which actually move the child are the selfish impulses of passion.
It were 03 warrantable to get enthusiastic about the purity and
innocence of a dog's mind. " A boy," says Plato, " is the most
vicious of all wild beasts" ; or, as some one else has put it, " a boy
ia better unborn than untaught." By nature sinful and vicious,
man acquires a knowledge of good through evil: not how evil
entered into him first, but how good first came out of him, is tiie
true scientific question: hia passions aie refined and developed
in a thousand channels through wider considerations of interest
and foresight ; the history of mental development begins with
the lowest passions, which flow as an under- cuii^ft^t \». tN^K-i

i

-M

I

I

PATHOLOGY OF MIKD. [ci

life, and frequently come to the surface iu a very turLulent way
in many lives. Kvil ia good in the making as vice is virtue in
the making.'

In the insanity of the young child we meet with passion in all
ita naked deformity and in all its exaggerated exhibition. The
instincts, appetites, or passions, call them as we may, manifest
themselves in unhluahing, extreme, and perverted action ; the
veil of any control which discipline may have fashioned ia rent ;
it J3 like the animal, and reveals ita animal nature with as Jittle
shame facedness as the monkey indulges its passions in the face
of all the world. Inasmuch as there is present only the instinct
to gratify itself, the concomitant of which is the effort to reject
or destroy what is not agreeable, its disease, if it hecouie Insane^
will be exhibited in a pei-verse and unceasing appropriation of
whatever attracts its notice, and in destructive attacks upon
whatever it can destroy. Eefuae it what it grasps at, and it will
scream, bite, and kick with a frantic energy : give it the object
which it is striving for, and it will smash it if it can : it is a
destructive little macluue which, being out of order, lays hold of
what ia suitable and what ia unsuitable, and subjects both alike
to ita desperate action. Haslam reports a case of thia kind in a
girl, aged three and a quarter years, who had become mad at two
and a half years of age, after inoculation for sniall-pox. Her
mother's brother was, however, an idiot, though her parents were
sane and undiseased. This creature struggled to get hold of
everything which she saw, and cried, bit, and kicked if she was
disappointed. Her appetite was voracious, and she would devour
any sort of food without discrimination ; she would rake out the
fire with her fingers, and seemed to forget that she had been

^ " I cannot praise," coBtirmea Milton, afler aaying- tliat we know good
by evil, "a fugitive and cIoiBtered virtue, unexercised and unbreatlied,
that never Balliea out and sees Ler adveraary, liut elinka out of the race
where that immortal garland ia to be run for, not without dust or lieftt
Assuredly we bring not innocence into the world, we bring impurity much
rather : that which purifies us is trial, and trial ia by what is eonlrary. , , .
That virtue therefore which is a youngling in the contemplation of evil.

and knows not the utmoat that Vice promiaea to her followera, and rejec^^^l

Iit, is but a blank virtue, not a pure ; her vliitcnesa is but an ejicrement^^^H
tffFest/tiaaa whiteness." T^^M

n.1 THE INSANITY OF EAI;LY LIFE.

1

burnt ; she passed her evacuations anywhere. She could not b©
taught anything, and never improved,'

The most striking exhibition of the destructive impulse which
sometimes reaches aa estceme degree in the madness of child-
hood i3 afforded by a homicidal teudeucy. " A girl, aged five
years, conceived a violent dislike to her stepmother, wlio had
always treated her kindly, and to her little brother, both of whom
she repeatedly attempted to kiU." * Here was a sort of conscious
design apparent in the act ; but it is obvious that the further
back in mental development we go, the less of conscious design
will there be in the morbid impulse. Moreover, in the case of
homicidal impulse in a young child, the consciousness of the end
or aim of the act must at best be very vague and imperfect ; it
is driven by an impulse of which it can give no account to a
destructive act, the real nature of which it does not appreciate ;
a natural instinct being exaggerated and perverted by disorder of
the nerve-centre. It matters not much, so far as its nature is
concerned, what is the particular form of the destructive impulse
— whether it be homicidal or suicidal, or to set fire to the house,
or to kiU a cat or a canaiy, or to smash crockery or other perish-
able ware ; the impulse which dominates it is as unreasoning
aud apparently uncontrollable as the convulsion of its limb is
in chorea. Many cases are on record of older children who have
displayed an incorrigible propensity to acts of pure cruelty and

» destruction, practised on such creatures as were not too powerful . M
to be their victims. ^^^

Thus much concerning those phenomena of insnnity in childreri-^^B
which spriug from the gross perversion of the self- conservative
impulse. Let me now say a few words concerning the perversion
of tlie instinct of propagation. It is necessary to guard against
a possible objection that this instinct is not felt until puberty.
There are certainly frequent manifestations of its existence
tliroughout early life, both in animals and in children, before
there is a consciousness of the aim or design of the blind im-
pulse. Whosoever avers otherwise must have paid very little
attention to the gambols of young animals, and must be strangely

^^■1 > Oiservaliims <m Maifnetn. ^^^^M

^^H 1 Esquirol, Traili da Maladki McnIuUs. ^^^H

r:
At
ant

PATHOLOGY OF MIKD. [CHJ

i

ot hypocritically oblivious of the events of his own early life.
At puberty the instinct makes its appearance in consciousness,
and thereupon attains to knowledge of its aim and cravea means
of gratification ; in like manner as, in the course of development
through the ages, the blind procreative instinct which is im-
manent in animal nature undergoes a marvellous evolution
within human consciousness, blossoming iuto all the glories of
human love.

Ab there are exhibitions of this blind impulse in the healthy
child, it is not surprising to meet with exaggerated and per-
verted manifest-ations of it in the insane child. The enthu-
siastic ideahst, greatly shocked by disgusting exhibitions of
unnatural precocity in children of three or four yeara of age,
exclaims against them as if tliey were unaccountable and
monstrous ; but they are not without interest to the scientific
observer, who sees in them valuable instances on which to base
hia generalisations concerning man, not as an ideal but as a real
being, and concerning his origin, not as a special creation, but
as the supreme product ot natiiral evolution. In the Philo-
sophical Transactions for 1745 is tlie account of a boy, aged only
two years and eleven months, wlio displayed a remarkable
sexual precocity, Esquirol quotes the case of a girl, aged three
years, who was constantly putting herself into the moat indecent
attitudes, and used to practise the most lascivious movements
against any convenient piece of furniture. At first the parents
thought nothing particular of it, but finding the practice con-
tinued, and of unmistakable significance, they tried every
means in their power to check it, hut without avail In church
or anywhere, at the sight of an agi'eeable object, there was the
same abandonment, ending in a general spasm. The child con-
fessed to a positive pleasure from the acts, continued tliem as
she grew up, and, though ultimately mai-ried, was a regular
nymphomaniac. Tlie greatest salacity was always manifested
from the beginning to the end of spring.i Other similar
examples of this sort of instinctive insanity might easily be
adduced ; for there are few physicians in practice who could not
relate instances of young children of three or foiu' years of age
aho MureVs Eti'dss Clini'ities aur he Muladies Mcn'aks. 1852.

VI.] THE INSANITY OP EARLY LIFE. 285

who have perplexed and distressed their parents by the preco-
cious display of active sexual tendencies. The afflicted creature
has no definite consciousness of the import of its precocious
acts ; certain attitudes and movements are the natural gesture-
language of certain internal states — ^their motor exponents ; and
it is little more than an organic machine automatically impelled
by disordered nerve-centres.

(b) Moral Insanity. — This variety of affective insanity might
be illustrated by numerous examples of all degrees of severity,
ranging from what might, not without reason, be described as
simple viciousness to those extremer manifestations which pass
far beyond the bounds of what any one would call vice. In the
spring of 1827, Dr. Prichard was asked to see the daughter of a
farmer, in some members of whose family insanity existed. She
was a little girl, aged seven, and was described as having been
quick at apprehension, lively, affectionate, and intelligent. A
great change, however, took place in her conduct : she became
rude, vulgar, abrupt, and perfectly unmanageable; doing no
work, running about the fields, and, if rebuked, very abusive
and extremely passionate. Her appetite was perverted so that
she preferred raw vegetables to her proper food ; and she would
sleep on the cold and wet ground rather than upon her bed.
Her parents had no control over her, and she was persistently
cruel to her sisters, pinching them when she could do so without
being observed. She had a complete knowledge of persons and
things, and recollected all that she had learned. Her eyes
glistened brilliantly; the conjunctiva was reddened; her head
was hot, her extremities were cold, and her bowels disordered ;
there was a disagreeable odour of the body. Dr, Prichard saw
her in the house of a medical man where she had been placed
because she was getting worse at home. " At this time she had
taken to eat her own faeces, and to drink her urine, and she
would swear like a fishwoman and destroy everything within
her reach ; yet she was fully conscious of everything she did,
and generally appeared to know well that she had done wrong/'
Aft^r doing something wrong she would exclaim, "Well, Mrs.
XL, I have done it. I know you will be angry ; but I can't help
it, and I could not let it alone until I had/' Axsv'^iw^V^^ t^'^^-

I

PATHOLOGY OP MIND. [ohaivJ

sures waa that of dirtying herself as frequeutly as she had clean
clothes put on ; indeed, " she would rarely pass her excrements
into the proper place, but reserved them for the carpet of the
Bitting-room, or for her own clean clothes." " At other times
she was so far conscious of her situation as to cry bitterly, and
express her feara that she would become like her aunt, who was
a maoiac. In addition to all these indications she had stolen
everything which she thought would be cared for, and either
hid or destroyed it ; and swore in langiiage which it is diihcult
to imagine that such a child could ever have heard." There
was no fixed idea which influenced her conduct ; she acted
"from the impulse of her feelings, and these were unnatural,
and perverted by disease." After two months she recovered.^

Haslam relates the following case of a young gentleman, aged
ten, in whose ancestors no insanity was acknowledged. When
only two years old, he waa so mischievous and uncontrollable
that he was sent from home ; and until he was nine years old
he continued "the creature of volition and the terror of the
family," and was indulged in every way ; he tore his clothes,
broke whatever he could break, and often would not take his
food. Severe discipline was tried, but in vain ; and the boy
■was ultimately sent to a lunatic asylum. There was deficient
sensibility of the skin, lie had a very retentive memory with
regard to matters which he had witnessed, but was attracted
only by fits and starts, so that he would not learn methodically :
he waa " the hopeless pupil of many masters," breaking windows,
crockery, and anything else which he could break. A cruel
trick of his was, whenever the cat came near bini, to seize it,
pluck out its whiskers with wonderful skill and rapidity, saying,
" I must have her beard off," and then commonly to throw it on
to the fire or through the window. He \vaa quite insenaible to
kindness, and never played with other boys. " Of his own
disorder he waa sometimes aenslble: he would often express
a wish to die, for he said very truly, ' God had not made him
like other children ; ' and when provoked he would- threaten to
destroy himself." No improvement took place.

1 On the Plfferent Formi of Inmnity in relation lo JuHsvruilcnei
I J. 0. PHlclinrd, il,D., 1842,

VI.] THE INSANITY OF EARLY LIFE. 287

A case in some respects similar is quoted by Moreau from
Eenaudin, under whose care it was : — A boy, whose intelligence
and behaviour were usually of an ordinary character, was subject
every now and then to a positive mania of acts, without any
mental incoherence.^ When these attacks came on him he was
quite incorrigible, and he had been expelled from different
schools in consequence of them. After several unsuccessful
trials at discipline, he was at last sent to an asylum. There he
answered quite intelligently, but wept and was silent when
spoken to about his bad conduct : pressed upon this subject, he
said that he could not help it The interesting circumstauce
was that there was a complete insensibility of the skin at the
time of the attacks of irresistible violence, and that in his docile
and affectionate intervals the sensibility of the skin was natural.
The acts of violence were of so extreme a character that, says
the reporter, " we were able to satisfy ourselves that they might
go as far as murder." ^

The special defective sensibility of skin in these cases is full
of instruction in relation to the profound and general defect or
perversion of the sensibility or receptive capacity of the whole
nervous system which is shown in their perverted likings and
dislikes, in their inability to join with other children in play or
work, and in the impossibility to modify their characters by
discipline ; they cannot feel impressions as they naturally should
feel them, nor adjust themselves to their surroundings, with
which they are in discord; and the motor outcomes of the
perverted affections of self are accordingly of a meaningless
and destructive character. The insensibility of skin is the out-
ward and visible sign of a corresponding inward and invisible
defect, as it notably is also in idiocy.

These examples may suflBice to illustrate a form of derange-
ment which undoubtedly occurs in early life, and which,
indeed, is more readily acknowledged when it is met with in
young children than when it is met with in the adult, in
whom it is more apt to be thought vice. The extreme acts of
precocious wickedness seem so inconsistent with the immaturity

^ Moreau's Psychohgie Morhide, p. 313.

2 I have related a case of moral insanity in a young girl in rcv^ ''ucyt^
On Respomihility in Mental Disease^ p. 180, tlaitd ft^\\\oTi.

PATHOLOGY OF MIND. [mkP.

of cliildhood that they are readily accounted unnatiiral, and
ascribed to disease. Howerer, to call tliem disease is not to
explain tliem, nor to cancel the need of an explanation. Wlio-
soever scnipulonsly traces the acts as the necessary consequences
of certain cuefiicient causes implied in the vitiated constitution
of the nerve element of the child, and thus banishes, aa he must
do, the notion of witting and wilful vice, will be hronght to own
in theory, as he will discover in practice, that like physical

f conditions in the adult may be the agents in producing like

) morbid effects.

There are children of a defective mental capacity, not reaching

I the degree of idiocy, or even of positive imbecility, whom it is
very difficult to know what to do with sometimes. They are
dull, heavy, stupid, appear indolent, indifferent, and as if they
will not try to learn anything, and display low or vicious tastes ;
when sent to a respectable school, they are commonly after some
time sent home again as impracticable. Their inability to leant
looks very much like stupidity and obstinacy, when it is really
e result of disease, and marks a certain rseaaure of imbecility.
Their nervous centres are ill fitted, by reason of some defect of

• constitution or of some gross morbid condition, to receive and to
retain impressions ; they lack, therefore, the disposition or desire
and the aptitude which are natural in a sound bodily state to
get into closer relations with the objects producing them; and
the motor reactions are not purposely made to repeat and to
vary the impressions until the objective causes of them are
thoroughly apprehended. It is sometimes the misfortune of

Iboya of this sort to be sent, after failing at the usual schools, to
some one who advertises for unruly pupils, and who represents
himself as possessed of some specific for managing and training
them. Some years since a boy of this kind was said to have
been flogged to death by his master, who was put upon his trial
for manslaughter, found guilty, and received a severe sentence.
Without doubt the poor boy was harshly and cruelly iised, but
there were some medical reasons for thinking that the case was
not q^uitc so bad as it was represented in the public papers at
tlic time. In some of these cases of semi-imbecility or stupidity
t/jcre is an abnormal quantity of serum in the ventricles of the

V1.J THE INSANITY OF EARLY LIFE. 28U

brain, and death may take place suddenly in consequence of
the increase of the fluid beyond a certain amount. In the case
referred to an unusual quantity of serum was found in the
ventricles of the brain after death ; and the medical man who
was called for the prosecution gave it as his opinion that this
was the result of the ill treatment to which the boy had been
subjected, and the probable cause of death. In reality, the
morbid condition of things may have been the cause of the
youth's stupidity, and so his death have been occasioned by a
punishment which would not have seriously injured a healthy
child. When we reflect on the possible state of things in the
brain, it will be obvious that no good, but much mischief, will
be done by harsh measures : patience and gentleness, kindness
and encouragement, good diet and regular habits, proper bodily
exercise, and the regular control of some judicious person, will
be the best means to employ. Above all things, it is well to
forego attempts to make such defectively organised beings reach
a degree of mental development which they are by nature
incapable of ; they should be put to some humble occupation
for which they are fitted, and in which they may succeed
fairly.

There is another class of boys who cause great trouble and
anxiety to their parents and to all persons who have to do with
them. Afiiicted with a positive moral imbecility, they are
inherently vicious; they are instinctive liars 'and thieves,
stealing and deceiving with a cunning and a skill which could
never be acquired; they have no trace of affection for their
parents or of good feeling for others ; the only care which they
have is to contrive means to indulge their passions and vicious
propensities, and this they will do with singular ingenuity and
acuteness. Intellectually some of them are defective also, for
they read no better when they are sixteen years old than a
healthy child of six years of age would do ; and yet these are
very cunning in deception and in gratifying the. desires of their
vicious natures. Others show no evident defect of intelligence ;
their general education may be fairly good, and some of them
shall display extraordinary cleverness of a particular kind ;
the surprising thing being that, having so acute axv vcdfc^X\^^^^^

I

290 PATHOLOay OF MIND. [en,

they sliould lie so utterly incapable an they are of seeing how
much theit conduct is against their true interest. However, bo
it is : their aelf-feeling is so intense and engrossing, that they
cannot look beyond the present gratification, and their intellect
IK enlisted entirely in its service. Oftentimes they are exceed-
ingly plausible, having a good address, impose skilfully upon
people whom they meet, and get out of scrapes in an extraordi-
narily clever way. When they are in trouble tliey express
the most bitter regret, write the most penitent letters, make the
most solemn promises of amendment, without the least sincerity,
or at any rate without making the Icaat effort to do right on the
next occasion when temptation comes. In one case a boy, who
was not fourteen years old when I saw Iiim, had been a troublfi
to his parents for years : he was most cunning and ingenious in
lying, showing a marvellous precocity therein, and a persistent
passion for it; used to abandon himself to paroxysms of violent
passion, and threaten or pretend to commit suicide; was acute
enough as regarded his personal interests, but could not learn
like other bays, nor did he associate with them; evhiced no
trace of moral element nor of social sympathy. He would
stand for an hoar at a time before a map of the woiQd while
other boys were at play, and could tell every place upon it where
a ship must call ; he could also tell every train in Bradshaw's
llaUway Guide on the Midland line. Another boy, who was the
son of a gentleman of higli social position, and had at command. _
everything a boy could wish for, could not be prevented frc
stealing wherever he went.

After puberty matters usually get worse in these cases: they,
give themselves up to intemperance, licentiousness, self-abuse, or
are guilty of steahng, of forgery, of unnatural offences, and of
other vices or actual crimes. If they are females, they abandon
tliemselvos to sexual indulgence ; or if they are prevented from
that by the restraints of their position in life, they may make
gross charges of immorality against innocent persons, perhaps
writing the filthiest anonymous letters. In a perverse mood they
may set fire to the house, or kill their employer's child, if they are

in service, rather tlian have the trouble to look after it. They are

^^^iSn/7>^ bedeviWed. AVhcn these degenerate beings belong to tl^^^H

md _

VI.] THE INSANITY OF EARLY LIFE. 291

lower classes, they find their way to prison many times — ^indeed,
they go to swell the criminal population of the country ; when
they helong to the better classes they are an infinite trouble, and
in order to keep them out of prison there is nothing for it but to
seek out some firm and judicious person who, for suitable remu-
neration, will take care of them, keep them out of mischief, and,
while checking theii* vicious propensities, try to discover and
foster any better tendencies which they may have in them.

In all cases of affective insanity, and especially of that variety
which I have described as moral insanity, the question of ques-
tions is hereditary taint. As the nature of man has grown
slowly to what it now is by a progressive fashioning through
generations, so by a retrogressive degeneration it passes back-
wards to a lower stage ; the stage to which it sinks being worse
than a corresponding stage of deficient development, because
while the latter marks an absence of, it is a corruption of,
the higher. The progress of organic development through the
ages is a progressive internal specialisation in relation to external
nature; the human organism, as the highest organic develop-
ment, has the most special and complex relations with the
external ; and the highest mental development, as the supreme
development of the human organism, represents the completest
expression of the most special and complex harmony between
man and nature. Now this concord will plainly be destroyed,
and a discord produced instead, by that inherent defect of nerve
element which an hereditary taint implies ; for it implies, as we
have seen, a predisposition to discordant action. Accordingly,
there is witnessed in the infant, long before any responsibility
attaches to its acts, either a congenital inability to respond to
external impressions, whereby idiocy of greater or less degree is
the consequence, or a defective nervous constitution, whereby
the natural assimilation of impressions and the fitting reaction
to them are seriously interfered with. In the worst cases .there
would seem to be a positive defect in the composition or consti-
tution of nervous element; its fundamental self-conservative
impulse, as living matter of specific quality, to be abolished.
The strange perversions of the child's appetites and instinctive
strivings evince this; instead of displaying an averaiotv fe^sv

I

PATHOLOGY OF MIND. [chak

fiwhftt is injurious and rejectiog it, the jouiig creature positivel;

[Seizes with eager appetite what ia most haneful.

In all degrees and kinds of healtliy life we witness in operar'
tion the attTadion of what is suitable to growth and development
and tlie repulsion of what is unsuitable : in the lowest forms of
life we describe them simply as attraction and repiilsion, or
assimilation and rejection ; as we rise higher in Ihe scale of life
the attraction becomes appetite and the repulsion becomes aver-
sion! higher still the attraction ia desire or love, the repulsion is
dislike or hate, although if there is any chai'acter of uncertainty
about the event, kope and /ear are used to express the opposite
tendencies; and the last and highest development of them is
willingne&s aud un\oillin<piess. But in the child which is born with
so strong a predisposition to insanity that it cannot develop, there
ia an absence of this pre-established hajmony between the in-
dividual constitution and external nature: the morbid creature
devours with eager appetite the gi-eatest trash, and rakes out the
fire with its fingers ; it desires passionately and struggles franti-
cally for what is detrimental to it, and rejects or destroys what
is suitable and should, were it rightly constituted, be agreeable ;
it lovea nothing but destructive and vicious acts, which are the
expressions of an advanced degradation, and hates that wliicii
would I'urther its development and is necessary to its existence
aa a social being. As it grows older, perversities of social feel-
ing and conduct mark its discordant bias. By reason of its
physical constitution it is a fundamental discord in nature; and
its perverse desires and doings are the outcome of a gradually
proceeding course of deteiioralion whereby it ultimately goes to
destruction. It cannot assimilate nature, and nature will there-
fore, sooner or later, assimilate it. Meanwhile, as a diseased
element in the social organism, it must be isolated or removed
for tlie good of the organism.

Aa the mad acts of the insane child mark a degenerate state
of nerve element, so it represents a degenerate viHety or morbid
kiml of human being. However low such a being may be
brought lie never reverts to the exact type of any animal ; the
fallen majesty of mankind appearing even in the worst wrecks.
There ia sometimes a general rcsctidihiucc to one of the lower

1

VI.] THE INSANITY OF EARLY LIFE. 293

animals, but the resemblance is no more than a general and super-
ficial one ; all the special differences of mental qualities are more
or less manifest just as all the special differences of anatomical
structure remain. The idiot, with hairy back, may go on his knees
and " bah " like a sheep, as did one of which Pinel tells ; but as
he does not get the wool and conformation of the sheep, so he does
not get its psychical characters : he is not adapted to the relations
of the sheep, and if placed in them, would surely perish, and he
does evince traces of adaptation to his relations as a human being
which the best developed animal never would. So also with
regard to man's next of kin, the monkeys : no possible arrest of
development, no degradation of human nature through genera-
tions, will bring him to the special type of the monkey: a
degenerate kind of human being is produced, but it is a morbid
kind, wanting the instincts of the lower animals, and the uncon-
scious upward aspirations of their nature, as well as the reason
of man and his conscious aspirations. It is a very rare thing,
for example, to meet among idiots with that instinctive discri-
mination of poisonous matters which some beasts have ; on the
other hand, it is very common to meet among them with a per-
verted craving for improper food or injurious substances, which
is in reality the unconscious display of nature's effort to extin-
guish a morbid variety, and which, but for charitable interference
and fostering care, would soon accomplish its aim.

Man exists in an intimate correlation with nature at its pre-
sent stage of development — is, as it were, the outgrowth at this
stage of its evolution, and therefore flourishes well under existing
conditions : the monkey, on the other hand, is not in harmony
with the complexity of surrounding nature, modified as this has
been so mightily by man, and is rapidly becoming extinct, the
stronger species surely superseding it. Were it desired to bring
man to the monkey level, it would be necessary to undo the
latest mighty chatiges in nature, and to restore the condition of
things which prevailed ages before he appeared, and of which
the monkey was the natural outgrowth. While, then, the monkey
type, and every other pure animal type, represent stages in the up-
ward development of nature, the theroid degenerations of man-
kind are pathological specimens, which, not b^m<^ ^^^xK^^-^i^^.

PATOOLOGY OF MIND. [r

for development, ai'e cast off by the stream of progress, and"
are on tlieir way to destruction, for re-issae by nature under
better form. By siicli examples of dehunianisation men are
taught how best to promote the progress of humaiiisation throu^
the ages. '

The foregoing considerations help us to understand how it ir
that we sometimes witness such a precocity of sReming vice in
the iusane infant or child. lunate in its human constitution
lurks the potentiality of a certain development, the latent power
of an actual evolution which no monkey ever has ; for in it ia
contained, as by involution, or implicitly comprehended, the in-
fluence of all mankind that has gone before. "When such a being
13 insane, there is not an individual creature only, but there is
human nature, in perverse action, in retrograde metamorphosis ;
we have actualised in morbid display certain potentialities of
humanity ; accordingly exhibitions of degenerate human action
are presented, which so far as regards the individual infant
seem to mark preniatuiity of vice, Humanity is contained in
the individual ; and in these strange morbid displays there is
an example of humanity undergoing resolution. Whatever act
of vice, of folly, of crime, of madnes.i one man has perpetrated,
there is in every man the potentiality of perpetrating ; if it were
not so, why repeat the decalague ? In the sense of anything in
nature being self-determined and self-sufficing, there is no indi-
viduality: as in one word are summed up the foregoing ages of
human cultivation, so in one mortal are summed up the foregoing
ages of human existence. Both in his knowledge and in hia
nature each one is Ihe inheritor of the acquisitions of the past —
the heir of all the ages. Take the word which represents the.;
subtile and, as itwere.petrified thought of ahigh mental cnltnre;!!
and trace back with analytical industry its genesis, — resolve it
into its elementary production, — what a long succession ofhuman
e.xperiences is unfolded ! AVhat a giadusl process of growth,
rising in speciality and complexity up to that organic evolution
which the word now marks, is displayed I Take, in like manner^
the individual being, and trace hack in imagination through tbi
long records of i^es the antecedent steps of his genesis, or observftj
intelligeBtly the resolution of his essential human nature as it]

i

VI.] THE INSANITY OF EARLY LIFE. 295

•

is exhibited in the degenerate acts of the insane child — in this
experiment thus obtruded on the attention by nature — and there
will then be no cause for surprise at phenomena which the young
creature could never have individually acquired, and which, so
far as its conscious life is concerned, appear strangely precocious
and inexplicabla There is the rapid undoing of what has been
slowly done through the ages ; the disruption and degenerate
manifestation of faculties which have been tediously acquired ;
the resolution of what has been the gain of a long process of
evolution ; the formless ruin of carefully fashioned form. We
are sad witnesses of the operation of a pathological law of
dehumanisation in producing dehumanised varieties of the
human kind.

I

I

M0CH discussion, into whicli I stall not enter here, lias taken
place at different times concerning the proper method of classify-
ing the varieties of mental deran<;emGnt, and as many as forty
or fifty different systems of classification have heen propounded:
a sufficient proof that no one has yet heen found to be satis-
factory. Some writers desire to have au exact pathological
basis for each of the varieties which they recognise, and throw
scorn on anytliing short of that, before they have done more
than cross the pathological threshold, and while they still
Inow nothing of what is going on in the intimate and inac-
cessible workings of nerve element. Doubtless, their day will
come a long time hence ; in the meantime we may pass them
by as persons whose eager aspirations have outrun practical
needs, and whose enthusiasm oftentimes forestalls observation,
Tiie commonly received classification is the least ambitious,
smce it is founded upon the recognition of tlie obvious differ-
ences of the mental features — that is to say, is entirely sympto-
matological ; it is simply a convenient scheme for grouping
together into some sort of provisional order phenomena which
resemble one another, without regard to their real nature, their
origin, and their essential relations, concerning all which it gives
no information. We group together under the name of Melan-
cholia a number of cases in which the symptoms are those of
great depression, and under the name of Mania other cases in
which the symptoms are those of exaltation and excitement,
notwithstanding that what seems to be tlie same cause may
produce the dejjresscil foi^m in one person and the excited form

CH. Ml.] THE SYMPTOMATOLOGY OP INSANITY. 297

in another, and that the disease may go through both forms in
the same person before it has mn its natural course. Clearly
such a classification of symptoms must be looked upon as pro-
visional ; but for the present ^it is convenient, and in truth neces-
sary. Were there no methodical classification of symptoms, an
author would be compelled on each occasion, when describing a
variety of mental derangement, to set forth the symptoms in
detail instead of denoting them by the general name of the
class, and there would be no end of his labour. This necessity
of calling up by a general term the conception of a certain co-
existence and sequence of symptoms is a reason why the old
classification holds its ground against classifications that are
alleged to be more scientific : it is good so far as it goes, but it
by no means goes to the root of the matter ; whereas the classifi-
cations which pretend to go to the root of the matter go beyond
what knowledge warrants, and are radically faulty.

Some persons exhibit eccentricities of thought, feeling, and
conduct, which, not reaching the degree of positive insanity,
nevertheless make them objects of remark in the world, and
cause difficulty sometimes when the question of legal or moral
responsibility is concerned. They are so unlike other people in
their feelings and thoughts, and do such odd things, that they
are thought to have a strain of madness in them ; they have
what may be called the insane temperament, — in other words,
a defective or unstable, condition of nerve element, which is
characterised by the disposition to sudden, singular, and im-
pulsive caprices of thought, feeling, and conduct. This con-
dition, in the causation of which hereditary taint is commonly
detectable, may be described as the Neurosis spasmodica or
Neurosis insana.

The Insane Temperament or Neurosis insana.

It is characterised by singularities or eccentricities of thought,
feeling, and action. It cannot truly be said of any one so con-
stituted that he is mad, but he is certainly strange, or " queer,"
or, as it is said, " not quite right." What he does he must often do
in a difierent way from all the rest of the world. If he thinks about
anything, he is apt to think about it under s^Iy^tv?^^ ^^x^^ ^^sss^

I

PATHOLOGY OF MIND. [chap.

relationR, which wouJd not have occurred to an ordinary person;
his feeling of an ever.t is unlite that which other people have
of it; he has perhaps the strangest twists and cranks of thought,
and is given to punning on woi-da ; and now and then he does
whimsical and apparently quite purposeless acts. There is in
the constitution an innate tendency to act independently as an
element in the social system, and there is a personal gratification
in the indulgence of such disposition, which to lookera-on seems
to mark great self- feeling and vanity ; he, however, is so exclu-
eively engi-ossed in the affection of sell' that he gratifies his
eccentric impulses without being conscious of the way in which
his conduct affects other persons. Such an one, therefore, is
looked upon by those who perform their duties in the social
system with equable regularity, thinking and feeling always
just as other people think and feel, as odd, queer, strange,
crochety, not quite right.

Tliis peculiarity of temperament, which is the sign and
perhaps the sanitary outlet of a predisposition to insanity,
borders very closely upon genius in some instances ; it is the
condition of the talent or wit which is allied to madness, being
only divided from it by thin partitions. The novel mode of
looking at things may be an actual advance upon the accepted
syetem of thought, and occasion a Hash of tnie insight; the
individual may bo in a minority of one, not because be sees less
than, or not so well as, all the world, but because he happens to
Bee deeper, and to have the intuition of some new truth. He
may differ ftx)m all the world, not because he is wrong and all
the world is right, but because he is rigiit and all the world is
wrong. Of necessity every new truth is at first in a minority
of one; it is a deviation from or a rebellion against the existing
system of belief; accordingly, the existing system, ever thinking
itself a finality, strives with all the weight of its established
organisftbion to crush it out. By the nature of things that must
happen, whether the novelty be a truth or an error. It is only
by the work of rebels in the social system that progress ia
achieved, and precisely because individuality is a reproacli, and
sneered at as an eccentricity, is it wull for the world, as Mrn

IyuceiiKi a.L aa uu t;ut:euLii(;ii.y, is il wcii loi luh wuiiu, ua -'■^'^n^^
Jl S. Miil pointed out, that individuality or eccentricity shoultf^|

Vii ] THE SYMPTOMATOLOGY OP INSANITY. 299

exist.^ It will not be amiss to set this matter forth at greater
length, to the end that we may, if possible, get a just conception
of the real relation of certain sorts of talent to insanity.

The genius is in the van of his age : in that wherein he is
ahead of it he necessarily differs from his age, and is often-
times therefore pronounced mistaken, unpractical, mad ; in that
wherein he agrees with his age, he is necessarily not original ;
and so appears the truth of an observation of Goethe, that
genius is in connection with its century only by its defects —
that in which it is not genius. Certainly the originality of a
man of true genius will grow out of the existing system, and
may be traced as a genetic evolution of it ; he is in radical con-
nection with his century ; but the more forward he has gone in
his development, the more he will outshoot his age and differ
from it. Accordingly, many a man of genius who has appeared
before his time — in other words, before the social organism has
reached that height of evolution which his thought marks — has
made little impression upon the world, and perhaps been alto-
gether overlooked or soon forgotten by it, having most likely
been thought more or less mad in his lifetime ; and the person
who usually gets most reputation, and whose name is made to
mark an epoch in development, is he who systematises and
definitely sets forth — that is, brings into illuminated conscious-
ness— the method which mankind has for some time been
instinctively and immethodically pursuing. A Bacon or a
Comte, being not really much in advance of his time, but having
eyes to discern the tendencies of development, and a capacity
of co-ordinating knowledge, is he who gets the most honour.
But even he is not honoured so much by his own age as by a
posterity which has grown to his level. We never see how high
the mountain is until we get some distance from it.

An inherent disposition of nature which renders a man dis-
satisfied with the existing state of things and urges him to
novel strivings, is really an essential condition of originality :
to suffer greatly, and to react with corresponding force, being a
means of dragging the world forward at the cost of individual
comfort. Consider, however, what an amount of innate power

* Essay on Liberty,

PATHOLOGY OF MIXD.

[CB

F"

^^B;& man must liave ia order to do that, witliout himself siDking

^^B nndtn' the imge weight of opposition ! Many eiiger and intense

^^L Teformeni, whosie vital energies hare been swallowed up in the

^^P fWssion and the proniulgatton of a truth, wiiich was perhaps an

^^K ImportaDt one, liave notoriously broken down in face of the

^^B crashing force of the organised opposition. They have been so

^^H niueh engrossed in their idea, so carried away by it, so blind to

^^K the force of the circumstances with which they have had to

^^P- contend, so abandoned to its prop^ation, so one-sided and

fanatical, as to be almost as heedless of the manifold relations

of their surroundings as actual madmen are; accordingly they

have often been called, and sometimes perhaps were, mad.

» Certainly their failures prove that they had not sufficient in-
tight, patience, and capacity for the task which they liad under-
tftkcn : tJiat they did not succeed is scientific proof that tliey
did not deserve to succeed. Howbeit they had not imme-
diate success, their work may not have been all in vain. The
heroes that have fallen in the lost field of the fight for the cause
^H that seemed to perish with them liave oftentimes risen to
^^h memory after many years of oblivion during which no man
^^B' apuke of them ; they liad struck a rift in the false doctrine,
^^1 *nd dropped a seedling of new truth into it, which, as it grew,
^^m opened gradually a wider and wider gap, and in full time
^^H shattered and silenced it.

^^m It is undoubtedly true that where hereditary taint exists in
^^B t family one member sometimes exhibits considerable genius,
^^1 when another is insane or epdepttc. The fact proves no more
^^m than that in both there has been a great natural sensibility
^^B which, under diiierent outward conditions of life, or different
^^B internal conditions of body, has issued differently in the two
^^B cases: the one lias been better endowed by nature or more
^^B favoured by fortune than the other. We may properly look at
^^B tlie function of unstable nerve element from two aspects— first,
^^B OB rcganls the reception of impressions ; and, secondly, as
^H regards the reaction to them. In the tii-st case we may liave
^^B one wlio is ei^ual to the ordinary events of a calm life, but who,
^^B ^uick to feel and slow to govern quick feeling, possessing no
^^^XBServe force of fnfierited ot actvwited endurance and enei^.

VII.] THE SYMPTOMATOLOGY OF INSANITY. 301

incapable alike of a steady subordination of self to events, and
of the power to subordinate events to self, is unequal to the
strain, and breaks down under the stress of adversity. And yet
his extreme nervous susceptibility may render him sensible o(
finer shades and more subtile delicacies of feeling and thought
than a more vigorously constituted being of coarser sensibilities
is. The defect, then, is in some respects an advantage, although
a rather perilous one, since it may go near the edge of madness.
Such men as Edgar Allan Poe and De Quincy illustrate this
great subtility of sensibility amounting almost to disease, and
so far give colour to the extravagant assertion of a French
author (Moreau de Tours), that a morbid state of nerve element
is the condition of genius. It must not be lost sight of, how-
ever, that a person so constituted is nowise an example of the
highest genius ; for he lacks, by reason of his great sensibility,
the power of calm, steady, and comprehensive mental assimila-
tion, and must fall short of the highest intellectual development.
Feeling events with a too great acuteness, he is incapacitated
from the calm discrimination of •the unlike, and the steady
assimilation of the like, in all sorts of them, grateful or ungrate-
ful, by which the integration of the highest mental faculties is
accomplished, — by which, in fact, the truly creative imagination
of the greatest poet and the powerful and almost intuitive ratio-
cination of the greatest philosopher are fashioned. His insight
may be marvellously subtile in certain cases, but he is not
sound and comprehensive. Albeit it might be said by one not
caring to be very exact that the genius of an acutely sensitive
and subjective poet betokened a morbid condition of nerve
element, yet no one, after a moment's sober reflection, would
venture to speak of the genius of such men as Shakspeare and
Goethe as arising out of a morbid condition.^ The impulse

* " So far from the position holding true, that great wit (or genius, in
our modem way of speaking) has a necessary alliance with insanity, tlie
greatest wits, on the contrary, will ever be found to be the sanest writers.
It is impossible for the mind to conceive of a mad Shakspeare. The
greatness of wit, by which the poetic talent is here chiefly to be under-
stood, manifests itself in the admirable balance of all tlie faculties. Mad-
ness is the disproportionate straining or excess of any one of them."—
Sanity of True Genius^ by Charles Lamb.

PATHOLOGY OF MIND. [c^

which iirgea these men to their high striving is not so mucIT
one of dissatisfaction as one of non-sat is faction — a craving, in
fact, for appropriation ; they want to feel and know ever more
and more of nature in all her mnltitudinoiia moods and aspects,
and to get into ever nearer and nearer relations of concord with
her ; their internal potentialities speak by a feeling of want, a
craving, an unsatialied instinct, not otherwise than as the lower
organic elements manifest their sense of hunger, or as the
sexual instinct reveals its want at puberty. The difference
between the desires which are tlie motives to action of the
Lighly-endowed, well-balanced natiire of the genius, and the
desires which inspire the eccentric and violent acts of the inci-
pient madman, is indeed very much like the difference between
the natumi feeling of hunger in the healthy organism, and the
vitiated appetite for garbage and dirt which the hysterical
■ ,* person displays occasionally. In the former case the aspiration
is sound, and acts to perfect a harmony between the individual
and nature ; in the latter, it is unsound, and tends to the pro-
duction of an irreconcilable. discord. The good organisation
hardly needs a long training ; it will make tlie means of its
<t training by the operation of its excellent affinities;
and it will thus, directly or cii-cuitously, attain to its best de-
velopment. The bad organisation, on the other hand, can only
be saved from degeneration by suitable training; if unguarded

■ by watchful control its natural afGuities will drag it downwards
to destruction.
A no less important difference between the highly- endowed
nervous constitution of the genius and the morbid nervous con-
stitution of the hereditary madman will appear when we look to
the reactive instead of the receptive side. The difference is not

Iunhke that which there is between a quiet aim-working voli-
tional act and a spasmodic movement. The acts of the genius
may be novel, transcending the estabhshed routine of thought
and conduct; but, however original and startling they appear
to those who work on with automatic regularity in the social
organisation, they contain, consciously or unconsciously, well-
formed design : implicit in them are the intuitive recognition of
and the intelligent respondence to outward relations ; in other

\

vii.] THE SYMPTOMATOLOGY OF INSANITY. 808

words, they are aim-working for the satisfaction of an inherent
impulse, which operates none the less wisely because there may
not be a distinct consciousness of its nature and aim. Inspira-
tion is the exact opposite in this regard of hahit or custom — that
" tyrant custom " which completely enslaves the whole manner
of thought and action of the majority of men : in the inspiration
of a great thought or deed there is the sudden starting forth into
consciousness of a new combination of elements unconsciously
present in the mind ; these having been steadily fashioned and
matured through previous experience. On the other hand, the
acts of the person who has the evil heritage of an insane tem-
perament are irregular, capricious, impulsive, and aim at the
satisfaction of no beneficial desire ; the outcome of a predisposi-
tion which is itself the materialisation of ancestral irregularities,
they tend to increase that discord between himself and nature
of which the aberrant acts are themselves evidence, and they
must end at last in his destruction.

I have lingered thus upon the relations which a form of
talent bears to insanity, in order to mark, if possible, the
character of each — so like on the surface, at bottom so unlike —
and its true position in the social organisation. A large genius
is plainly not in the least akin to madness ; but between these
widely separated conditions a series of connections is made by
persons who stand out from the throng of men by the possession
of special talents in particular lines of development; and it is
they who, displaying a mixture of madness and genius at the
same time, have given rise to the opinion that great wit is allied
to madness. They are said perhaps to have too much imagina-
tion ; by which is meant not that they have a large, calm, well-
stored, and truly informed imagination, but a narrow, intense,
ill informed imagination that works wildly without due nourish-
ment of facts and undisciplined by habitual obedience to law —
in other words, a one-sided and defective imagination.^ With

^ There never was a truly great imagination without great understand-
ing : and it is ridiculous to attempt to separate them. To say that women
have more imagination than men, and that the savage has more imagina-
tion than the civilised man, is nonsense ; for it is to call by the higher
name what is a negation of the best imagination, and the product of in-
tellectual barrenness and want of training in observation and t^^^^XKssa..

U

I

I

L

80-1 PATHOLOGY OF MIND. [chap.

true genius there may be an nncommon deviation from the usual
course of things ; but there is tlie full recognition of the existing
organisatiou as the basis of a higher development, a fusing of the
past through a new mould into the future; in insanity these is a
capricious rebellion, aa the initiation of a hopeless discord. A
man of deep insight and comprehensive view may penetrate be-
neath the masks of things, and see into the real nature of many
- of the illusions set up by common consent to be worshipped,
but he atill finds a real truth and meaning beneath the fleeting
phenomena, and he accepts with equanimity the present, not as
the end, but as means to an end, perceiving in it the prophecy of
a completer future ; he subordinates his aelf-hood to the system,
works quietly and sincerely in. his sphere, and is moved by no
passion springing from offended self-love to set the world vio-
lently right. He can perceive the urgent need of reform, and
long for its coming, without going mad with vexation and injured
self-love because it plainly will not come to pass in his day and
by his means. The man of great self-feeling, on the other hand,
may penetrate the incompleteness, the inadequacy, the empti-
ness of many existing doctrines and practices, but he ia too apt
to find the whole ridiculous, not having calm enough apprehen-
sion to lay hold of the degree of trutli which lies often at the
bottom of seeming shams ; he deems himself thorouglily emanci-
pated when he is actually the unconscious slave of an extrava-
gant self-feeling, by reason of which he is made angry with the
comedy of life, is instant to do some great thing, passionately
earnest to set the world right with a one-sided vehemence:
there is the reaction of a great self-love which incapacitates its
possessor, or rather its victim, from subordinating his self-hood
to the laws of the existing organisation. Has not Goethe put
this truth tersely and well in the words, " The man of under-
standing finds almost everything ridiculous ; the man of reason
hardly anything " ?

When the heritage of an insane temperament exists, it will of
course depend much on the internal bodily conditions and the
external circumstances of life whether the mischief shall remain
dormant or shall issue in positive insanity. In favourable cir-
■umatances it may manife,st itself only in harmless eccentrieilies

VII.] THE SYMPTOMATOLOGY OP INSANITY. 806

and caprices ; but if the person is placed under conditions
of great excitement, or subjected to severe mental strain, the
inherent propensity is apt to display itself in an impulsive
act of violence, or in an outbreak of some form of mental de-
rangement. One sees from time to time brothers who have
presumably had the same neurotic inheritance go very different
ways, and reach very different ends, in life, according to the
different conditions on which each has chanced to light; the*
one perhaps gaining position and fortune, the other ending in
suicide or in a lunatic asylum. The great internal disturbance
produced in young girls at the time of puberty is well known
to be an occasional cause of strange morbid feelings and extra-
ordinary acts, particularly where the insane temperament exists :
in such case irregularities of menstruation, always apt enough
to disturb the mental equilibrium, may give rise to an outbreak
of mania, or to extreme moral perversion more afflicting to the
patient's friends than mania because seemingly wilful. The
stress of a great disappointment, or any other of the recognised
causes of mental disease, will meet with a powerful co-operat-
ing cause in the constitutional predisposition. On this matter,
however, enough has already been said when treating of the
causation of insanity.

A description of the peculiarities of mind and body which
mark the varieties of the insane temperament would assuredly
be both interesting and useful But the study, which has yet
to be made, will be difiBcult, and the description more difficult
still, for it will mean the exact delineation of glances, gestures,
attitudes, turns of thought, of feeling, and of expression, which,
albeit they are distinctly recognised when they are seen, cannot
well be set forth by a verbal description.

A quality of mind which is pretty well common to all the
varieties of the temperament, but marks one variety of it in
particular, is an intense self-feeling, which has various sorts of
expression in character. One might name this the egoistic
variety. Everything is looked at in the light in which it affects
self ; there is a singular and serenely unconscious incapacity to
look at self or the incidents which affect it from any outside
standpoint. What will be noted in some instances \9» \}£n»5^ *^^

'■^

I

f iJOG PATHOLOGY OF MIKD. [ci

self-foeliDg widens to embrace the family -without going a step
farther in expansion. There ia then an intense family feeling;
the members constitute, as it were, one self, feel with one another
in a close and narrow sympathy, measure all their doings and
other persons' doings by the standard of family feeling, and are
little or not at all affected by the opinions which outsiders may
entertain or by the interests which they may have Such per-
sons think how things will affect their sensibilities and judge
them accordingly, instead of ever thinking how they may be
fitted to discipline and improve their sensibilities, and how well
it might he that they were used for that end ; exact with serene
unconsciousness of selfishness the labour and sacrifices of others,
as if it were in the natural order of events that they should use
all men and be used of none,-should be considered of all and
should consider none ; are so entirely engulfed in exaggerated
family feeling that they do not perceive the family oddities and
failings of character, but perhaps look upon and even foster
them as something higher than the virtues of other families ;
are shut off by their narrow sympathies from anything like a
large and healthy hold on the wide and manifold interests of
human life, and from the beneficial discipline of thought and
feeling which a wider experience would exert upon them.
Withal they are capable sometimes of extraordinary self-sacrifice
for one another.

The fact is that they are too much akin in character ; they
Jiave been bred too much alike ; the strain wants variety ;
and their best chance to go through life without breaking
down into mental derangement themselves, or without breeding
such derangement in the next generation, ia to he separated
widely from one another, and to be placed in different condi-
tions of life, whereby more healthy differentiations of cha-
racter may be produced. One notices perhaps in families of
tliis kind that the member who has been abroad in the world,
and haa mixed among men in various parts, and participated
in their interests and doings, is the only one who displays a
fairly rational and healthy tone of mind; and for the same
^reason the men of these families, who, being obliged in their
jntercomss with the world to check the gross display, have so in

VII.] THE SYMPTOMATOLOGY OF INSANITY. 307

some measure checked the growth, of the habit of morbid
suspicion and exacting selfishness, are better disciplined in mind
than the women who stay at home and nurse their narrow
sympathies in a narrow sphere. However, let the stress be great
enough, the fundamental feeling will seldom fail to come out
even in those who have undergone the most varied discipline.

A more marked variety of an insane temperament shows
itself in an extremely suspicious and distrustful nature; it
might be named the suspicious variety, for the suspicion is
morbidly acute and intense. Persons of this disposition often-
times show not less, if not more, distrust when they meet with
fair and open dealing, which is antipathetic to their natures,
than when they are in face of fraud and duplicity, with which
their natures are sympathetic; not being able to divine the
interested motive which they cannot help believing to instigate
the most candid advice, they cannot digest it, and imagine it to
be too deep and inscrutable for them, whilst fraud is a congenial
flattery of their characters ; so it comes to pass that they become
the easy dupes of plausible impostors, who, pandering to their
foibles, play upon their infirmities. Moreover, any strange doc-
trine which is based upon a distrust of what the majority of men
believe, and is a rebellion against the accepted system of thought
and practice, has a pathological attraction for their intensely
distrustful natures; not because they have anything like an
adequate knowledge of the errors of what they reject or of the
merits of what they embrace, but simply because the latter is
heterodox. With this suspicion of others goes insincerity in
themselves ; distrustful, they are untrustworthy. Having little
or no sympathy with their own healthy kind, they sometimes
display extraordinary affection for a cat or a dog, and arrogate
to themselves a superior humanity because of their greater affec-
tion for animals than for men. I need not repeat what I said
formerly of the secret ways, the suspicious imaginings, the
exacting distrusts, the duplicity of those near relatives of insane
persons who, having this unhappy temperament, ask advice,
follow it not faithfully, and then blame the giver when the
issue is not happy. With the morbid habit of mind goes some-
times a corresponding habit of bodily ex5Tes>svcyci. — ^^ ^<^^^^ss.^^

^^^08 PATHOLOGV OF MIMD. [ouj^^

I

I
I

furtive glance, an unsteady, vacillating eye wliicU cannot look
fiill and frankly into another person's eye; a stealthy, cat-like
step and sneaking attitude; nothing like frank outlook, erect
■bearing, firm and manly gait. In some instances an effusive can-
dour and an apologetic humility of manner beguile the unwary
into a belief of their sincerity, which is after all perhaps genuine
at the moment. Entirely possessed for the time by the feeling
which the occasion kindles, they express it freely ; tlieir whole
conscious state is, as it were, the vibration of the momentary
emotion, an exclusive energy ; but when its flame subsides, as it
quickly does, and reflection begins, their normal suspicious
functions regain their hold, and they act as if the previous de-
monstrative expression of feeling had been false and hypocritical.
It was as much out of relation with their normal mental func-
tions as a muscular spasm is out of relation with normal mus-
cular action. Hypocritical without doubt it was so far as real
sincerity of the whole nature was concerned, hut not quite
consciously so at the time.

It has been noticed in several instances that members of the
same family who have become insane have laboured under the
same form of disease or under similar actual delusions. In one
family three brothers end a sister, who were all the inenibeis of
it of their generation, went mad one after another, and tliey all
had similar delusions of conspiracy and persecution. Their
mother, who was not supposed to be insane, was the most
suspicious and distrustful person whom I have ever met : on
one occasion she declared to me, in an outburst of momentary
sincerity, that she never trusted anybody, for she had been so
often deceived. Tliere was no reason to believe that she had
fared worse in the world in that respect than other people, and
naturally her words stirred the sad reflection how much better
for her family it would have been had she trusted more and
I suspected less.' I call to mind another case in which three

' This lady was much hurt, niid never forgave me for htivirg been
tlioroughly candid with her. She had buoyed lierBolf up with hopes, that
Irnd no real foundation, tliat a demented son would recover, and liad glndly
iccepted tlie Imlf promisee of cure wliiuh diiferent doctora whom she had
consulted liad given her, abusing them afterwards for deceiving lier,
JVJjea 1 to}ii Ler iliat his case was truly hopeless, and that she ahould

VII.] THE SYMPTOMATOLOGY OF INSANITY. 809

sisters became insane, and all had similar delusions that they
were poisoned by chemical fumes and tortured by magnetism :
it was the more remarkable an instance because they had
married and had been separated in their lives. Everybody must
have noticed how exactly like one another in thoughts, feelings,
and ways two or three maiden sisters who have always lived
together become ; so that when one of them falls insane it is a
long time before the others perceive or acknowledge it, and not
always easy for an observer to say offhand which is the patient.
A writer in a German medical journal gives an account of
a whole family who became insane.^ The family consisted of
father, mother, and six grown-up children. From time to time
they used to appear before the central authorities of the depart-
ment to complain that they had been plundered of their property
by the magistrates of their district. It was entirely a delusion.
They had shut themselves up in their house, abandoning the
cultivation of their land, and would listen to neither entreaties,
arguments, nor remonstmnces from their neighbours, who out ol
compassion had gathered in theii* crops for them. They lived in
a miserable manner, used no fire, and washed their clothes with-
out soap in a neighbouring brook ; a deputation of them going
from time to time to the authorities to complain of the injury
that had been done to them. This went on for nine years.
Eventually two of the younger members left home to take
situations, and another died. At last, the father died in the
winter of want and cold, and one winter's night the mother died
on the road as she was returning from one of her fruitless
expeditions to obtain redress. The three who were left, two
sisters and a brother, were then sent to a lunatic asylum. One
of the sisters, who was microcephalic and somewhat weak-
minded, got rid of her delusions of persecution at the end
of eight months and became a useful servant. The brother too
left the asylum and obtained employment; but the eldest sister
remained under the influence of her delusion, and was angry and

make her plans accordingly, she was indignant, exclaiming, " Why do you
tell me that I " and no doubt had recourse to some one who was willing to
deceive her again.

1 Zeitschnft /. Psychiatrie, B. 29, H. 2.

L wEo I

I

PATHOLOGY OF MIND. [<

abnsive when contradicted The concluaioii of the physician
inquired carefully into the history of this family was that the
mother and daughter had been genuinely insane, having the
delusion that they were persecuted, and that they had succeeded
in infecting with it the other members of a not strong-minded
family, who would no doubt have escaped had the mother and
daughter been removed to an asylum at the outset.

In the Annales Midico-Psychologiquex, 1S63, Dr. Bonnet gives
a remarkable account of suicidal insanity in twin brothers,
Martin and Francis, They were robbed of 300 franca. One
morning afterwards the brothers, who lived several milea apart,
had a similar di-eam at the same hour, three o'clock KM., and
awoke in great agitation, shouting, " I catch tlie thief; he is
injuring my brother." Martin's agitation increased; he com-
plained of violent pains in his head, declared he was lost, and,
eluding observation, ran to the river and attempted to drown
himself, hut was rescued. In the evening he was removed to
an asylum, francis, who had become calm after his first
excitement, shouted that his brother was lost, on seeing him
taken away, that he was mistaken for the thief, that they were
going to kill him; complained soon after of violent pains in
his head, declared he was lost, and attempted to drown himself
at the same spot where his brother had done. He was soon got
out of the water, but could not be restored. Martin died three
days after his admission into the asylum, having remained in a
continuous state of excitement unto the end.'

The form of mental derangement which is most likely to be

communicated in this way by a sort of infection or sympathy is

I that which is characterised by groundless apprehensions and

' In different numbera of Ota Aniialet Medico-Peyc}\ohgique» hre tfAaieU
several caaes o( this sort of coram unicAted insanity. Among the rest tha
enBo of twin^ Mistera, one of wliora, afflicted \vitli feera tnd delusiona of
persecution, infected tlie otber, who soon recovered her Henses when
Bsparaied froni her sister. In lie AimaUs Midico-FsychologiquK of July,
1876, is mentioned the case of a French soldier who imagined himself hod
iif the Emperor of Austria, and that ho would be crowned in Paris orin
noma: he travelled in Italy, Sjiain, and Prance to attain his end. His
twin-brother, who aacompanied him in his trBTels, believed in his delusions,
find had eiactly similar ones, hinfjiiiing that he would bo c

^_ find had eiactly similar ones, ninjjming that he would bo crowned OC^H
^^L Hume when his brother wns crowned at Paris. ^^H

ni.] THE SYMPTOMATOLOGY OF INSANITY. 311

delusions of persecution. No wonder, considering how easily
suspicion is stirred up in some minds, and how quickly, once
raised, it creates imaginary proofs of hostility, and feeds itself
upon the delusive evidences thereof How much more is this so
in the suspicion of the insane temperament ! The explanation
of such infections is to be sought, as before indicated, partly in
the essential likeness of nature in members of the same family,
whereby they are disposed to feel and think alike, and to foster
one another's habits of thought and feeling by sympathy ; and
partly in the absence of external dififerentiating influences, owin«;
to the fact that they live in the same narrow conditions of life,
have the same mean hopes and fears, and pursue the same petty
ends by the same means. By a sort of pre-established harmou}'
of nature their minds are attuned to chime together, and they
naturally do so when they are struck by the same impressiouvs.
Habits of thought may thus grow side by side in two persons,
and at the same rate, into a common delusion, or — what is more
likely — the stronger character succeeds in impressing its delusion
upon the weaker mind.

Another variety of the insane temperament is characterized
by extreme irresolution and vacillation; it might be truly
described as the vacillating or self-tormenting variety. Those
who have this temperament are distressed beyond measure
when they have to decide anything, however trivial, cannot
come to a decision out of apprehension lest it should be wrong,
and worry themselves and others with the many times reiterated
arguments for and against. Although the decision is not of the
least consequence, whichever way it goes, it causes them the
utmost mental tribulation, and engages them hour after hour in
over-anxious considerations of a really puerile character ; and
when the decision has been made there is an instant fear that it
has been wrong, and an instant relapse into the self-torturing
ingenuity of discovering objections to what has been decided
and of conjuring up the best reasons in favour of what was not
decided. Whatever they have done they persuade themselves
they ought not to have done, and what they have left undone
that they think they ought to have done. Thus they go on
from day to day, from month to month, a plague to themselves

^V S12 PATHOLOGY OF MIND. [-D

and to others with their brain-sick scruples and fears. If it were
some great thing concerning which they dubitated and wavered,
one would not think it anywise strange, for the habit of thinking,
Hamlet-like, too precisely over the event, which sicklies o'er the
native hue of resolution with the pale cast of thought, belongs
to certain minds of greai capacity in which the intellectual pre-
dominates over the affective element; but it is about the meanest
and most insignificant affairs of daily life, as, for example, what
di'ess shall be put on, which side of the street they shall take,
whether they shall travel by one train or another, what order
shall be given to the cook for dinner, and the like, that they are
thus mightily concerned. I call to mind one lady, whose lather
had committed suicide, and who herself had been afflicted with
a great weariness of life and with frequently upstarting ideas
how well it would be if it were over, who positively dreaded to
rise from her bed in the mornmg, because of the suffering which
she knew she must undergo in settling what dress she would
wear, and who declared that she went through agonies each
morning before she could summon resolution to give orders for
the day's dinner; and the case of a gentleman having both
mother and brother hopelessly insane, who, although he had no
profession, nor business, nor real work of any kind, was rest-
lessly busy all day in deUberating upon the trifles of domestic
concern which he did not find time enough to settle. For when
the matter had been gone into fully, and all the reasons on one
eide and on the other set forth elaborately, and the course of
action at last fixed upon, he would, notwithstanding that he

*was aware of his teasing infirmity, begin again at the beginning
<<ea if nothing had been said.
Nearly akin to this variety of unsound temperament is that
in which an idea oi impulse, oftentimes of a trivial or even
ridiculous nature, springs up in the mind and takes such hold ol'
it that it gives the person no rest until he has yielded to it ; I
may call it, for distinction's sake, the impulsive variety of self-
tormenb, In one case a man's life was a series of successive
struggles to resist ideas which were always annoying, oftentimes
^^ distressing, and sometimes ridiculously foolish ; he must enter a ^^
^^ 'house with a certain foot first, for if ho succeeded by a stxoim^^^

VII.] THE SYMPTOMATOLOGY OF INSANITY. 313

eflfoit over himself to conquer the whim by putting the other
foot first, it was a terrible wrench to him, and he had no rest of
mind until he had gone out of the house and re-entered it with
the proper foot first ; he must take particular notice of a name
or of a number over a shop-door, and if he resolutely turned
his eyes away as he passed the door, he was obliged in the end
to turn back in order to look at the name or number, having
gone back more than a mile on one occasion to do so after he
had made a supreme effort to be master of the absurd impulse ;
if it came into his mind that he must move a particular book or
piece of paper on the table for no reason whatever — and whims
of that kind were constantly coming into his mind — he had
learned by long experience that be would have no peace of mind
until he succumbed. He was not an idle man who had nothing
to do but brood over these impulses and so magnify them, but
gained his livelihood by manual labour ; was moreover unusually
intelligent, and quite as conscious of their morbid character,
and of the propriety of withstanding them, as any one else
could be, but he came of a family in which there was mental
disease.

In another case a gentleman of good means and position,
having an insane brother, was tormented with similar impulses of
a ridiculous nature. In all outward seeming he was so sound that
no one of his acquaintances except one or two friends to whom he
had confided his troubles had the least notion how he was afflicted.
Many were his battles against the tormenting impulses, but he
was forced to succumb to them in the end, for after prolonged
struggle he would become extremely agitated and distressed,
break out into a violent perspiration, and tremble as much as if
he had just had a terrible fright. Once when driving along the
public road he chanced to notice two stones on the top of a high
wall, whereupon it instantly came into his mind that he must
have them down. The wall was too high for him to reach them,
and the absurdity of taking a ladder there in the day-time in
order to get at them helped him to resist the impulse, which he
did during what he described as a most miserable fortnight ; but
at the end of that time he went secretly out of the town by
night to the wall, taking with him a long whip, with the lash, of

^^pto4 PATHOLOGY OF MIND. [CB«^^|

which he succeeded, after several attempts, in dra^ng the stones
down. After that he had rest of mind until a new impulse took
hold of hiin.

I shall mention only one instance more of this self -torturing
habit of mind, which shows itself in all sorts of wliims, of the
absurdity of which the person is perfectly aware — for example,
in tliinking constantly of particular numbers or particular words
and tlien noticing that they appear with mysterious frequency
on all sorts of occasions ; iu asking himself the reason of some
very common thing, and the reason again of that, and so going
back in questioning without end ; in groundless apprehensions of
having said or done something which, although perfectly innocent
of harm and not of the least consequence, may have Injured
some one ; in fears lest he should be made to do unconsciously at
some time a ridiculous or improper act, to which he feels an
impulse that he is resisting successfully for the present. The
loss of control over the ideas and feelings of wluch he has such
painful experience brings home to liim the alarming conviction
that he is at the mercy of an accident and may be precipitated
into doing some day what he apprehends with fear and trembling -
and he will burst into tears and sob piteously as he tells the sad
fltory of his fears and struggles.

Tiie following story is in the words of a gentleman who coi
suited me, and who had written it out for me when he came :*■

I

4

" I inherit from my father's family a troublesome liver ; fi-om my
I mother's a singularly nervous temperament, which has exhibited
itself in soveral members of the family. One of my ancles was
subject to sti-ange halluoinatioDa, whicli took what I beUeve is the
not unoommo^ form of the fear of a design upon his Ufe, even from
his own family ; he had also a belief that some hostile supernatural

I agency was at work to frustrate his designs.
As far bock as I can remembe-r, my life has been troubled
•ome form or other of nervous irritation.
As a very littln child, I remoraber, I attached a peculiar import-
ance to certitiin numbers ; this or that trivial action m.ust be accom-
panied by counting so many, or the action must be repeated so many
times ; later, certain of these nuinbei's assumed a speciiil importanoe ;

^

St.] THE SYMPTOMATOLOGY OF INSANITY. 3]fi.|

tliree, or any maltiple, must be avoided in ordinary actions as being
in some sort sacred to tbe Holy Trinity. An imperative netesaity
seemed laid upon me to touch or move this or that object, thongh
I might have no desire to do so ; and, as I think ia related of Dr.
Johnson, I would submit to no little inconvenience to avoid tread-
ing upon tbe joins of tbo paving stones. Generally 1 may say that
that which was lenat pleasant seemed most frtrongly obligatory ; for
example, if I chanced to be walking with any one, the impulse to
pick up a chance straw in the path waa greatly stronger than if I
were alone, though (or perhaps, because) I was very sensitive to fear
of my peculiarities being known ; and, ngain, though I was fantas. ■
tically particular as to cleanliness, 1 waseppeciallyimpelled totonch I
some dirty or offensive object. I remember putting myself to con-
siderable trouble to go out again after reaching home to move soma
trifling thing I had chanced to notice on the pavement. To resirt
these impulses was very painful, though to yield was of little ad
vantage, as the one satisfied was quickly followed by another. I .
read, as 1 remember, one of those weird German tnles, which mads 1
a strong impression upon my mind ; it was the story of one of those '
compacts with tbe devil which form the subject of eomany legends;
the one, I think, on which Der Freigehutz ia founded. For a long
time the formula which was to constitute the contract was constantly
recurring to my thoughts, and a sort of necessity seemed imposed'
upon me to give it mental assent. As it was necessary that it should
bo ihoaght, I was obliged, if I may so express myself, to think it
negatively, and so to avoid, as it seemed to me, taking tbe terrible
pledge. For a very long time after this particular fancy bad lost
its hold, tbe phrase thus I'eversed was continually recurring to my
mind. Jn a similar way a prompting to say or to think some sen-
tence of malediction against God had to be met by adding a nega-
tive and some expression of blessing or praise. Later, as a youth of
eighteen or thereabouts, an imaginary obligation under fancied oi
of a terrible character to do any tiifling thing was the source oi
little trouble to me. I do not mean that I believed that I had at I
some former time taken such an oath, but that the mere occurrence
oE the thought of the oaths, though without the assent of my >
seemed, to my disordered sense of conscientiousness, to make it '
binding upon me ; under the influence of this feeling, I would
peat some remai'k in conversation which I had already made, I would j
take a turning in the street, which n-as out of my way, or b^L^ s

PATHOLOGY OF MIND.

[ca

artide I Bftw in a shop window For which I had no use. Trifling na
Biich things may aeem in the reciial. the ftmount of ineonvenienco
caused was often very eonHiiierable, and the teirible aenae of one of
these obligations nnfultilled would cause me often the most ii
unhnppineaa.

"Though these thinga could scarcely help heing noticed, yet!
think not even those of my own. family ever knew the extent
which I was troubled. I was living, as it were, a kind of double
life, one part full of wretchedness, the other that of a reserved and
studious boy ; and in 8pit« of lengthy absences from school from
ill-heaJth, which prevented anything like Hoholarship, I was com-
monly regarded as intelligent in ordinary affairs, both at school and
at home. For some years after entering my profeaaion, though never
ijuite free from mental excitement, I was much less disturbed than
in my boyhood, so much as to lead me to hnpe that I was gi-owing
into a normal state of mental health. For some time past, however,
I have had a recurrence of the old affection in a new form. There
except when the mind is fully occupied by any quite engrossing
iployment, a prompting which reaches almost to a physical neces-
sity, to give utterance to some blasphemous or obscene speech. As
I pass through the streets, or on any one entering the room in which I
may be, some phrase of this character presents itself to my mind,
and, as it were, insists upon being spoken ; any conscious effort seeraa
to inci'ease the evil, and evidently, though lam compelled to keep a
constant watch upon myself, that very fact tends to increase the
nervous excitement. I am unconscious sometimes whether I have
spoken or not, for, unnatural as it seems, the thought is so vivii
present to my mind, or the uneasiness it produces so absorbe
whole attention, that I cannot trust either to my own ears or
Lips. The only sort of assurance I can give myself is by liti
holding my tongue, the tip firmly between the teeth, and so rend)
ing it physically impossible to utter distinct speech."

me oi
iten^^H

yat^H

te
wil'
in

liat

K

The last case which I have to mention is that of an exceediQ)
[ntelligent and accomplished elderly gentleman who had sf
with distinction in the army ; he had been an opinm-eater
in his younger days, and not temperate in other respects. He
had now abandoned the taking of opium, and was most temperate
fin liabits and careful in diet. He lived in two rooms, out ~

1

VII.] THE SYMPTOMATOLOGY OF INSANITY. 317

which he could not bear to go, from fear of occasioning bodily
suffering to himself by exposure to sun or wind or from some
other cause ; could not read himself, although a well-cultivated
person, because he thought it injured him to do so, and accord-
ingly engaged some one to read to him daily. His mind was
extremely active, but he was tormented by what he called
" fads ; " something came into his mind to be said or done, gene-
rally of the most trifling nature, as, for example, to move a lamp
on the table a few inches from where it stood, or to touch some
object as he passed it, and he had thereupon an irresistible im-
pulse to go on repeating the act over and over again ; however
long and resolutely he resisted, he was obliged to succumb, for he
had no peace of mind until he did. He could relinquish a "fad"
of this sort at last in an indirect way by writing it down in a
book after he had repeated it so many times, and he had accord-
ingly made long records of pacified " fads " ; but the misfortune
was that he had no sooner got rid of one in this way than another
would take its place and similarly harass him. He was obliged
thereupon to go through the same process of repetition with it
until he could turn it, so to speak, and so get past it. He had
consulted several physicians about his state, and had taken counsel
with clergymen ; the latter he had called to his aid because,
being a religious person, he was unspeakably tormented by ap-
prehensions that he had not used exactly the right word in his
prayers, and by impulses to go on repeating words. Oftentimes
when he touched something the idea occurred to him that his
hands must be soiled, and he felt that he must then touch some-
thing else, and so was obliged to go on touching one thing
after another until he was wearied. In consequence of this ten-
dency his morning ofiices occupied him for a long time every day-
No one could have had a more exact knowledge of his state than
he had, or perceived more clearly the absurdity of his bondage,
but he had not the least power to deliver himself from it.

Another mode of outcome of the insane temperament is an
extreme miserliness. With a remarkable unconsciousness of
any display of selfishness the individual tenaciously claims and
takes and holds to all he can get in a way which would rouse
some sense of shame in a person who had ivo\)\X\^ \5ea^^^'5CK^je^\

^m

f ial8 PATHOLOGY OF MIND,

he, however, engrossed in the narrow desii'sa of an intense self-
hood, without a touch of generosity, feels nob the least aense of
ahame. He persistently accumulates and lays up money which
he needs not, without designing to make any use of it either for
his own benefit or for the benefit of others ; acting in fact as if
he were carefully laying by stores which be would take with binn
when be went dowu to the grave and have great use of on tbe
other side thereof. He loses all sight of the end in tbe means,
and meanly toils for the meaua as if they were tbe end. " Thou
fool I this night thy soul shall he required of thee," would be too
flattering a speech to one whose life is proof of the abseuce of a
soul in the true sense of the word. He is not one with his kind ;
, shut up in a narrow selfishness, he fulfills not tbe functions of a
sound element in the social organiaafcion; heison theway to, ifhe
does not actually reach, morbid degeneracy. So long as grapes
do nob grow on thorns nor figs on thistles, we cannot expect such
a one to beget healthy children ; if be has any, they will mosb
likely run in either an insane or a criminal groove.

The last variety of the insane temperament which I shall
mention is that which is characterised by a complete or almost
complete absence of the moral sense. Of course the varieties
which have gone before might in one sense be called instances of
defective moral sense, but in them there has been an extravagant
growth of some egoistic passion, the hypertrophy of which has
entailed an atrophy of sound social feeling ; not an original
privation of moral sensibility, a moral imbecility, such as I
am convinced ia sometimes tbe consequence of a bad descent.

■ T have already described instances of young cliildren sprung
from insane families who have presented a complete moral
imbecility, or have precociously displayed very definite immoral
tendencies, and I shall have occasion, later on, to describe a
genuine moral insanity in adults, and to point out its hereditary
antecedents. Short of actual derangement which calls for in-
terference, we meet with all degrees of moral deficiency in
individuals, and sometimes with an extraordinary deficiency
going along with a superior intelligence. It is easy to imder-

1 stand that bhis should be when we call to mind what has heen^^_
said in foregoing pages cmiccrning tbe evolution of the nioiH^H

VII.] THE SYMPTOMATOLOGY OF INSANITY. 319

sense in mankind; concerning the fundamental meaning of
insanity as an aberrant phenomenon ; concerning the near rela-
tions which sometimes subsist between crime and insanity ; and
lastly concerning the fundamental characteristic of an insane
temperament. This temperament really means nothing more of
course than an unsound temperament ; the unsoundness con-
sists in some defect or exaggeration of qualities which unfits
it to adapt itself thoroughly to its social surroundings, and so to
take its proper part in the social organisation, predisposing it
to go the downward way of neurotic degeneracy until an actual
morbid variety is produced either in its generation or in the
generation which follows it. It will be found as a matter of
experience, however, that the person who has it does not usually
go actually mad himself; he is proof of madness in his family
and is not unlikely to beget madness, but he remains himself
much the same peculiar being all his days — near the border
of madness, but not over it — and combining even sometimes
extraordinary talent with his peculiarities.

There is a peculiar infirmity which I have noticed once or
twice in persons who have had a marked neurotic inheritance,
namely, an inability to look over a large space such as a wide
expanse of sea or plain without feeling very giddy and strangely
apprensive. One gentleman who consulted me about the in-
sanity of his brother could never bear to look from a height
over a large plain of country because of the distressing vertigo
which it occasioned him : it was not any fear of falling from
a height but the spacious view which produced the effect, for
he had the same feeling if he were on the sea-shore or on a
mound only, from which there was no possibility of falling,
T observe that Keichenbach had noticed something of the same
kind in some of his so-called sensitives : one of them could
not look at a large plain because it made her sick; another
always avoided an open square, and preferred to go through
the alleys rather than cross it ; to another a waving field of
corn was disagreeable, because she felt as though she were
being rocked by it and would vomit if she did not turn
away. Dr. Westphal has described as agoraphohia a species of
insanity which is characterised by the inability to ^\^^%% 'ss>c

^B op

PATHOLOGY OF MIND. [(

open square. The condition marks a natural instability of motor
centres lilie that which is acquired by the drunken man who
steadies himself to cross a street by fixing hia eyes intently on
some object on the opposite side. The vertiginous feeling ia the
subjective aspect of the instability of the motor centres.

With the mental peculiarities which mark an insane tempera-
ment usually go peculiarities of features, of manner, of gait,
and of other bodily movements that are modes of mental ex-
pression. Were we only clever enough to read the language, past
all doubt a man's mind might always be discovered in hia fea-
tures and his bodily attitudes. In the insane temperament
these characters are oftentimes so peculiar as to attract instant
notice. "This fatal heiilage," says Eaquirol, speaking of exti-eme
cases, " ia paiuted upon the physiognomy, on the external form,
on the ideas, the passions, the habits, tiie inclinations of those
who ace victims of it" It is hard to describe special traits of
address and expression, which are nevertheless easily perceived
when they are met with. A so-called " nervous manner," which
is a common enough expression, covers in reality a variety of
peculiarities : one person's address is uncertain, abrupt, jerky,
and when he offers his hand it is with the air of a person who
presents a pistol at you ; another's is shy, hesitating, awkward,
and instead of looking towards the person whom he approaches
as he enters a room, or whom he is addressing, he rolls his eyes
away strangely to the right or left or directs his gaze aimlessly
to the ceiling ; in other cases the movements are constant, rest-
leas, purposeless, or sometimes grotesque and uncouth.

There is occasionally a fixed, full, unfathomable look or stai'c
which I have noticed in the eyes of persons who have inherited
ft decided predisposition to insanity ; I recognise it, hut cannot
describe it; it ia aa though they were preoccupied with somt'
undercurrent of thought different from that wliich is con-
cerned in the conversation which they ai'a holding. One feel-
instinctively that what one says to them is not going sincerely
to the bottom of their minds. I have noticed it particularly in
cases of mental depression in which there has been a suicidal
feeling, and eventually perhaps a suicidal deed.

In some instances a singular inconsistency or incohei

la^M

VII.] THE SYMPTOMATOLOGY OF INSANITY. 321

of features may be noticed; one part of the face shall be
wreathed in smiles while the rest of the features are not in
hannony with it, but have perhaps a grave and sober ex-
pression ; or, in spite of what is being talked about being of a
serious nature, there may be a nervous laugh on the face which
is quite out of harmony with the mood of mind. Again I have
noticed sometimes that a smile or laugh over the face shall not
pass away gradually and change into a sober expression, as it
naturally should, but shall be arrested abruptly in the middle
of it and changed suddenly into a blank, abstracted, and rather
vacant look of seriousness, without any corresponding abrupt
change in the mental mood, so far as can be judged. This
abrupt supervention of a vacant and abstracted look in the
midst of ordinary conversation, without anything having been
said to provoke it, may justly excite suspicion of a person's
heritage. Lastly, one may remark in other cases an extra-
ordinary mobility of features, which fall into as many and
meaningless grimaces as those of an excited monkey, and
especially of the eyes, which roll about or oscillate aimlessly as
if they had broken loose from the bonds of ordinary expression
and were making revolutions on their own account. With such
grimacing features goes a grimacing mind — a twisted-minded -
ness, if I may so speak. When one eye rolls about out of
accord with the other, as it does in some persons, I am not
aware that it is the mark of an insane temperament, but is it
not associated frequently with a duplicity of character ? The
peculiarities of physiognomy which I have indicated seem to fall
mainly under two heads — first, an incoherence between moods of
mind and their natural facial expressions, and, secondly, an in-
coherence of the special features which constitute the natural
expression of a mood — a sort of dislocation or discontinuity of
muscular function. The mind's expressions, like its functions,
evince a tendency to incoherenae.

These traits of expression are consistent with sanity of mind ;
they are not adduced as evidence of actual mental derangement,
but as signs of a temperament which will usually be seen on
inquiry to own a neurotic inheritance or be observed to found
one. But in extremer cases of hereditary deg^\\ex^'c^ ^Xv'^^-^'SsSiaS.

PATHOLOGY OF MIND. [(M

1 of defect are more inarktd. The physiognomy has uot
^ularity and harmony, but shows irregalarity, discordauce, or
■.actual distortion of featuroa ; there is sometimes an irregular
l conformation of the head, one side of which may be larger than,
I or differently shaped from, the other ; the ears are not well and
regularly planted, nor perhaps properly formed in all tlieir parts,
and there may be actual deformity of one or both of them, as
Morel has pointed out; convulsions have perhaps occurred in
early life, and some sort of spaamodic movement or tic of certain

» muscles may continue throughout lifa In the worst cases,
-Trhere degeneracy has reached the depth of imbecility, the walk
is vacillating and uncertain, and there is sometimes a dispro-
portion between the limbs. It would be true probably to say
that no one who lacks power to use and govern his muscles will
be capable of good power of attention. Arrest of development
of the sexual organs is not very uncommon ; slight diseases
readily take on a fatal character, so little is the power of vital
resistance ; and the mean duration of life among those strongly
marked by this fatal heritage is less than the average.

There are corresponding peculiarities of disposition: Morel, of
Eouen, to whom we are most indebted for the scientific investi-
gation of these victims of degeneracy, described them as purely
instiuctive beings; they display instinctively certain remarkable
talents, as for music, drawing, calculation, or ediibit a prodigious
memory for details ; but they are incapable of sustained thought
and work — they cannot bring anything to a steady perfection,
" do not know that they know, do not think that they think ; "

»and under any great strain they are almost certain to break
down into insanity, or to explode in some act of violence. It is
remarkable nevertheless how much talent of a particular kind
may coexist sometimes with these extreme forms of degeneracy;
as if to show how much of the acquisitions of conntless ages of
mankind is now contained in the most degenerate specimens —

I what an infinitely sublimed heritage of eons of culture belongs
to the essence of any human being of civilised parentaga I
once saw a little girl, let. five, imbecile from birth by reason of
hereditary degeneracy, who could not speak a word, screamed
frightfully, and was so mischievous and destructive that sha

ni.] THE SYMPTOMATOLOGY OF INSANITY. 323

could not be left alone for a miuute ; yet she could hum
correctly many tunes — her mother counted as many as twenty.
As the result of his elaborate researches, Morel came to the
conclusion that " in the inferior varieties of degenerate beings a
like physical type is to be observed amongst all the individuals
that compose these varieties, and a certain conformity in their
intellectual and moral tendencies. They betray their origin by
the manifestation of the same character, the same manners, the
same temperament, the same instincts. These analogies establish
amongst degenerate individuals under the same causes the bond
of a pathological relationship." Forget not that between the
extreme forms of this degeneracy and those slight eccentricities
compatible with high talent there are to be met with cases
marking every shade of the long gradation.

Closely allied to the insane temperament is that which exists
in those more or less hysterical women, mostly under thirty
years of age, who are the favourite subjects of mesmeric experi-
ments and of religious revivals, and who commonly exhibit some
peculiarity of nervous constitution, such as catalepsy, paralysis,
somnambulism, or spasmodic affections. Having no well-formed
will of their own, they become the easy victims of ideas forcibly
impressed upon them by others. Their spasmodic temperament,
unfavourable to the proper co-ordination of ideas and feelings,
is eminently favourable to the morbid exaggeration of some
feeling or idea and to spasmodic movements. A further con-
sequence of this bad organisation in most of these cases is a
strangely perverted or defective moral nature. Certain women
exhibit a desire for and a love of imposture which approaches
a moral insanity : will blacken their eyelids with some pigment
in order to look and be thought ill, when they are in good bodily
health ; will lie in bed for months or even years, affirming that
they are paralysed, when the only paralysis they have is one of
moral energy ; will undergo extraordinary sufferings and priva-
tions in order to substantiate some outrageous fraud which they
are practising; openly refuse all food for weeks, in order to
produce the belief that they live without food ; drink what
urine they clandestinely pass, in order to have it believed that
they never pass any ; and bum or blister their arxxv^ ^xAV^'^^^

^

J

i'^^^l

PATHOLOGY OF MISD. [(

with some corrosive fluid, in order to fabricate a peculiar skin-
disease. The religious ecstatica of the middle ages belonged
doubtless to this class ; the miraeuloua stigmata which they
exhibited being aa fictitious as the diseases which their sisters
of the present day fabricate or counterfeit, A\lien t!ie vagaries
of hysteria affect the mind rather than the body, as they are apt
to do where the insane temperament exists, they occasion many
extraordinary symptoms-
Hysteria is notably a very vague term used to include a mass
of functional nervous disorders of all sorts and degrees, which
are certainly not as distinctly marked out from one another as
it is desirable they should be. One character they have in
common, namely, that they suggest the notion of a counterfeit-
ing of disease ; a group or succession of symptoms which would
be of grave omen otherwise are known not to be of grave omen
when it can be said of them that they are only hysterical ;
wherefore, not having the significance which they seem or affect
to have as the exponents of serious disease, they necessarily
have the look of pretence or feigning. The appearance of un-
reality is further strengthened by the fact that in many cases the
malady can be checked instantly by the will when it is vigor-
ously roused by a strong enough motive, and that in. other cases
it may be gradually suppressed, as will is strengthened steadily
by a suitable moral discipline, such discipline being the best
treatment of the malady. The two principal features then
which attract notice in all so-called hysterical cases are a
seeming simulation of disease in protean forms and an ener-
vation of will. Let it not be supposed, however, that the
eimulation is voluntary or even conscious in the majority of
cases ; although the symptoms do not mark the disease whicli
they seem to mark, do not mean epilepsy, for example, when
they are violent convulsions of an epileptiform character, they
are none tlie less the outcome of a genuine disorder of the
nervous system, and of a disorder which is nearly allied to that
which exists in catalepsy, in ecstasy, and in those hybrid forms
of convulsive seizures which we are at a loss sometimes whether
to call hyeteiia or genuine epilepsy.
For the most jiart we hardly take sn fficicTit account of the fact

VII.] THE SYMPTOMATOLOGY OF INSANITY. 326

that mimicry is a natural function of the nervous system, consti-
tuting the very basis of its culture, and that the tendency in many
nervous disorders is to exaggerate much and even to simulate
symptoms, apart from any question of intentional deceit. This
tendency it is which will can combat and sometimes inhibit or
hold entirely in check, whence the universal counsel to so-called
nervous patients not to give way to distressing feelings and in-
clinations to do nothing, but to fight against them : it is counsel
easily given, but hard to follow, since the misfortune is that the
disorder which strengthens the tendency weakens the will, and
so leaves less power to control what is more difiBcult of control.
Be this as it may, however, it is plain that there may be all
degrees of apparent or of real simulation in different instances
— a gradation, in fact, ranging from an entirely unconscious
mimicry down to deliberate fraud. We are in the habit of
making in our conceptions so complete a separation between the
physical and the volitional action of the nervous system, looking
upon the will as something constant, psychical, and entirely
apart, that we cannot help holding that it either absolutely is
or is not in any given function ; we find it hard or impossible to
conceive that it may present all degrees of degradation and that
its basis is truly physical Involuntary perverse conduct of a
voluntary kind, convulsions of voluntary movements, perverse
pleasure in self-torture, are expressions which would convey the
best notion of the behaviour of some hysterical patients, if they
were not self-contradictory ; but self-contradictory as they seem,
I am inclined to think that they are not so mutually exclusive
as the received doctrines of psychology would indicate. How-
ever, they will certainly be thought so ; for it will be a long
time yet before it will be possible to bridge the gulf between
physiological conceptions of the functions of mind and the usual
conceptions of it.

Thus much concerning some peculiarities of an insane tem-
perament which stop short of actual insanity. I go on now to
treat of the varieties of actual mental derangement from a
symptomatological point of view.

r'' — '■ — V
ffi!6 PATHOLOGY OF MIND. [cB^^^I

Varieiics of Symptoms of Actual Insanity. ^^^|

A passing survey of the inmates of n lunatic asylum coraP^^

I

hardly fail to strike tlie mind of an unskilled observer with thfi
perception of two principal classes of opposite symptoma; he
would notice tliat there were some whose evory attitude, word,
and thou<>ht helolcened the deepest depression of mind, and
others who betrayed an opposite state of exaltation of mind in
their look, their gait, and in everytliing which they said and did.
These opposite symptoms marls the two great divisions of Melan-
cholia and Mania, which correspond again to the two funda-
mental affections of self in wJiich all the pas:;ionB have their
roots : on the one hand, a painful affection of self which shows
itself in sad feelings, thoughts, and conduct ; and, on tiie other
hand, an expansion or elation of self which is expnisasd in
answering feelings, thoughts, and deeds.

A closer examination would show the observer that wliile the
derangement of mind was complete in some patients and be-
trayed itself in almost everything which they said and did, in
othera it was limited apparently to a few fixed ideas, apart from
which they thought, felt, and ai:ted very much lilce other men.
Marking these differences by another division, we have, first,
Mania divided into general and pai'tial, the latter known com-
monly as Monomania, because of the opinion that the madness
is limited to one subject ; and secondly, MelanclioUa, divided
likewise into General and Partial, the latter, although not now
commonly distinguished, being what Esq^uirol described as
Lypemania, In regard to both these forma of so-called partial
insanity it may be noted at once t